El aborto. Análisis crítico de la situación actual

The author begins this work by making an exposition of those facts which we could call fundamental from the biological point of view to understand and judge the different birth control methods in use today. From the very moment of the fertilization of the ovum by the spermatozoid. the development plans of a new organism become imprinted. This new organism is endowed with an extraordinary functional capacity whose determination is unaffected by the relations between the maternal organism and the fetal organismo These facts are so apparent that. Jf the beginning of Iife is not located in fecundation . there exist no concrete re· ferences as to when it does in fact take place. Abortive birth control methods are those which interrupt embryonic -or fetal- development. no matter the mechanism of action employed nor the time elapsed since the fertilization of the ovum. The spreading of these abortive methods has been noteworthy. with the proliferation of contraceptive methods -mainly the hormonal ones (the «pill .. )which have served as the key which has opened the door for abortion. Jt can be demonstrated how in these last fifteen years the relation between contraceptives and abortion is indeed intimate, and it beco mes difficult to separate them in practice. The laws promulgated in a large number of countries in recent years approving abortion have created in the public at large a conceptual confusion which makes that «Iegalized», .inducedD, «provoked», «criminal» ... abortions become differentiated only with sorne difficulty, whereas in point of fact the differences are quite c1ear. The only abortion which can be conside'red legal is spontaneous abortion (miscarriage) which occurs independently of the will of the mother and that of the doctor; all other cases deal with provoked abortion and signify the direct death of an individual. Jt is no doubt true that juridical legality do es not necessarily identify itself with ethical norms and that it cannot be the fundament of doctrinal norms of conduct; it is precisely from this that even «Iegalized» abortion continues to be a crime. Finally, the author makes reference to the relations between abortion and euthanasia which are increasing evident as time goes by. It is foreseeable that in the next few years the first laws allowing euthanasia will be approved, signifying yet a further step in the escalation of the anti-life movement

Transvaginal color Doppler assessment of venous flow in adnexal masses

Objective To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses. Material and Methods Ninety-one consecutive patients (mean age: 46.6 years, range: 16–81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut-off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was ≤ 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was ≥ the best cut-off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B-mode morphology (evaluation performed according to Sassone’s scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated. Results Twenty-five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut-off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively. Conclusions Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors

Nuevos’ y ‘viejos’ liderazgos: la campaña de las elecciones generales españolas de 2015 en Twitter

El objetivo de esta investigación es analizar la actividad en Twitter, durante la campaña de las Elecciones Generales de 2015 en España, por parte de los líderes de los principales partidos políticos españoles: Mariano Rajoy (PP), Pedro Sánchez (PSOE), Pablo Iglesias (Podemos) y Albert Rivera (Ciudadanos). Más concretamente: cuántos mensajes, y de qué tipo, publicaron; en qué asuntos concentraron su atención; y de qué forma, o formas, preferenciales usaron Twitter: para difundir mensajes políticos, hacer referencia a las actividades del candidato en los medios o en la agenda de la campaña, o bien para enfatizar cuestiones personales. El planteamiento metodológico de la investigación está estructurado en tres áreas complementarias: a) un análisis cuantitativo de los tuits publicados por los cuatro candidatos a lo largo de la campaña, centrado en determinar el porcentaje de respuestas y retuits; b) un análisis de contenido que permita delinear la agenda temática de cada candidato; y c) un análisis cualitativo que nos permita obtener una visión de conjunto de las preferencias comunicativas y el perfil en Twitter de cada candidato. Los resultados combinados de este triple enfoque metodológico muestran que los candidatos de los partidos emergentes tienden a enviar mensajes para movilizar a sus seguidores en campaña y para hacer anuncios genéricos que pronostican su futura victoria y la llegada de un cambio político, mientras que los líderes de PP y PSOE tienden a publicar más mensajes con propuestas programáticas específicas

Scientific power in the Spanish press during the pandemic: a portrait of new leaders while explaining its risk

This work is based on the mediatisation of society theory, which establishes more attached importance and the presence of the mass media as mediators in various social processes, as well as on Production Studies, that analyse creative skills to draw an audience, to apply these theories to the media representation of the COVID-19 pandemic. The objective is to analyse how the generalist media have represented male/female scientists, who have become social benchmarks during the first COVID-19 wave in Spain. Our initial hypothesis considers that the purpose of the mediatisation of scientific discourse was to contribute answers to, and to keep society calm, in an uncertainty context. By content and discourse analyses with a sample formed by 172 pieces of work published between 25 January and 5 July 2020 in four Spanish digital newspapers, we observed how these specialists not only became the usual sources of journalistic information but were also the main leading figures in them. The mass media pay attention to their statements, but also to their aesthetics and communication style, which are singular compared to conventional power to date. Science enters the national section with its own image and explanatory intentionality. Nonetheless, constant overexposure and its link with governments making controversial decisions influence the image held by the public opinion of scientists with time, which dissociates them from its knowledge and identifies them with political power.Este trabajo parte de la teoría de la mediatización de la sociedad, que establece el aumento de la importancia y presencia de los medios de comunicación como mediadores en diversos procesos sociales, así como de los Estudios de Producción, que analizan las habilidades creativas para atraer a la audiencia, para aplicarla a la representación mediática de la pandemia de COVID-19. El objetivo es analizar cómo medios generalistas han representado a los y las científicas convertidos en referentes sociales durante la primera ola en España. Nuestra hipótesis de partida considera que la mediatización del discurso científico ha tenido como propósito aportar respuestas y tranquilidad a la sociedad en un contexto de incertidumbre. A través del análisis de contenido y del análisis del discurso de una muestra formada por 172 piezas publicadas entre el 25 de enero y el 5 de julio de 2020en cuatro diarios digitales españoles, se observa que estos especialistas no solo se han convertido en fuentes habituales de las informaciones periodísticas, sino que en ocasiones incluso las protagonizan. Los medios de comunicación prestan atención a sus declaraciones, pero también a su estética y estilo de comunicación, singular frente al poder convencional hasta ahora. La ciencia entra en la sección de Nacional con imagen propia e intencionalidad explicativa. No obstante, la sobreexposición continua y el vínculo con gobiernos que toman decisiones polémicas influye con el paso del tiempo en la imagen que la opinión pública genera de los científicos, los desvincula de su conocimiento y los identifica con el poder político

Prevención cardiovascular y de la osteoporosis con terapia hormonal sustitutiva

Se recomienda actualmente que todo médico -sea cual sea su especialidad- aproveche la oportunidad que supone la atención clínica a cualquier mujer postmenopáusica o que se halle en torno a la menopausia para aconsejarle acerca de los beneficios y riesgos que supone la terapia hormonal sustitutiva (THS) con estrógenos y progesterona. Una vez que sea adecuadamente informada de estos beneficios y riesgos, debe ser la propia mujer quien decida si va a iniciar o no esta terapia, teniendo en cuenta no sólo su propio perfil de riesgo sino también sus preferencias. Los beneficios más claros se refieren a la reducción del riesgo de osteoporosis y de fracturas, así como al control y prevención de algunos síntomas frecuentes en la menopausia. Para prevenir la osteoporosis se requiere un uso continuado de IaTHS. También existen cada vez más argumentos que sugieren una reducción del riesgo de un primer episodio coronario. No obstante, no hay pruebas de que laTHS sea útil en la prevención secundaria de la cardiopatía isquémica o aporte alguna protección frente a los accidentes cerebrovasculares. Las desventajas más importantes de la THS se refieren a un mayor riesgo de hiperplasia de endometrio y de cáncer endometrial cuando se usan estrógenos solos, sin combinarlos con progestágenos. También existe un pequeño incremento del riesgo de cáncer de mama cuando se prolonga la THS, también cuando se asocian progestágenos

Comparative study of transvaginal ultrasonography and CA 125 in the preoperative evaluation of myometrial invasion in endometrial carcinoma

To compare the ability of transvaginal sonography and serum CA 125 levels to predict myometrial invasion in patients with endometrial carcinoma. DESIGN AND METHODS: Prospective study in 50 consecutive patients (mean age 60 years, SD 10.5, range 29-77 years) diagnosed as having endometrial cancer and scheduled for surgical staging. All patients were evaluated by transvaginal ultrasonography. Endometrial thickness was measured in all cases and myometrial invasion was estimated as or = 50%. Serum CA 125 level was determined in each patient. A cut-off level of > or = 35 IU/ml was considered to predict myometrial invasion of > or = 50%. All patients underwent surgical staging, and definitive histopathological findings regarding myometrial invasion were used as the 'gold standard'. Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were calculated for transvaginal ultrasonography and CA 125 and compared. RESULTS: On histopathological analysis, myometrial invasion was found to be or = 50% in 15 cases (30%). Mean endometrial thickness in patients with superficial invasion was significantly lower than in those with deep invasion (13.4 mm (95% CI 11.2-15.7) vs. 18.7 mm (95% CI 15.0-22.3), respectively; p = 0.014). Median CA 125 was significantly higher in patients with deep invasion than in those with superficial invasion (30 IU/ml, interquartile range (IQR) 46.0 vs. 16.9 IU/ml, IQR 13.9, respectively; p = 0.002). The sensitivity, specificity, PPV and NPV for transvaginal ultrasonography were 86.7% (95% CI 59.5-98.3), 94.3% (95% CI 80.8-99.3), 86.7% (95% CI 59.5-98.3) and 94.3% (95% CI 80.8-99.3), respectively. The sensitivity, specificity, PPV and NPV for CA 125 were 40% (95% CI 16.3-67.7), 91.4% (95% CI 76.9-98.2), 66.7% (95% CI 29.9-92.5) and 78% (95% CI 63.4-89.5), respectively. The sensitivity of transvaginal ultrasonography was significantly higher than that of CA 125 (p = 0.008). No differences were found in terms of specificity, PPV or NPV. CONCLUSION: Our results indicate that transvaginal ultrasonography is more sensitive than CA 125 in predicting myometrial invasion in endometrial cancer

Is expectant management of sonographically benign adnexal cysts an option in selected asymptomatic premenopausal women?

The objective was to assess whether expectant management of sonographically benign ovarian cysts may be an option for selected asymptomatic premenopausal women. METHODS: This is a prospective observational longitudinal study. Between January 1997 and December 2002, 323 asymptomatic premenopausal women (mean age: 40.6 years; range: 19-50 years) diagnosed as having a sonographically benign ovarian cyst measuring <6 cm were offered conservative management with periodic follow-up at 6-12 month intervals. In all cases, a first check was performed 3 months after diagnosis to confirm the 'persistent' nature of the cyst. A total of 120 women agreed to participate in this study and constitute the basis of the data presented. RESULTS: Mean diameter at diagnosis for the most frequent lesions were as follows: endometrioma 3.3 cm (SD 1.5); simple cyst 4.1 cm (SD 1.6); dermoid cyst 3.2 cm (SD 1.4); haemorrhagic cyst 3.5 cm (SD 1.2); hydrosalpinx 2.9 cm (SD 1.0). With a median follow-up of 42 months (range: 18-94 months), most lesions remained unchanged, both in size and sonographic appearance. Ten cysts (8.3%) disappeared during follow-up, all of them after more than 2 years of follow-up. No patient has developed signs or symptoms suggesting ovarian cancer. CONCLUSION: Most sonographically benign ovarian cysts remain unchanged during long-term follow-up. Our data would support conservative management in these cases

Cáncer de mama durante el embarazo

As women in western countries delay childbearing, it has been hypothesized that the incidence of breast cancer diagnosed during pregnancy will increase. Breast carcinoma during pregnancy(BCP) put the health of the mother in conflict with that of the fetus. The aim is to give optimal treatment to the mother to maximise the chances of survival, whilst minimising the risk of harm of the fetus. Few breast surgeons or oncologist develop expertise in this area owing the rarity of the association. We report the epidemiology, pathology, clinical picture, therapeutic management and fetal outcome of pregnant women with breast cancer treated in our institutio

Grossesse tubaire rompue associée à une grossesse utérine évolutive

Reconnaître une grossesse ectopique, disait Werth cité par Mondor [14], est facile dans bien des cas, mais dans d'autres cas qui ne sont pas nombreux c'est l'une des épreuves les plus difficiles de diagnostic gynécologique et beaucoup de gynécologues exercés ont dû s'y arrêter plus d'une fois. Werth pensait certainement aux formes atypiques et peut-être aussi à la forme associant grossesses intra-utérine et extra-utérine puisque la première description autopsique de Duvernet date de 1708 [2, 4, 5, 10, 11]. Pour insister davantage sur la dificulté diagnostique de cette forme particulière, nous rapportons une observation clinique, avec revue de la littérature, afin de dégager quelques points de discussion car cette association, non exceptionnelle, n'est plus une curiosité médicale et mérite d'être connue du moins à cause de sa relative fréquence et de sa gravité