M García Manero

Universidad de Navarra, Pamplona, Navarre, Spain

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Publications (36)35.5 Total impact

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    ABSTRACT: Thrombospondin-1 serum levels is correlate with pelvic pain in patients with ovarian endometriosis. Thrombospondin-1 serum levels were prospectively analysed in 51 patients (group A asymptomatic patients or patients presenting mild dysmenorrhea and women comprised group B severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists among thrombospondin-1 serum levels and pelvic pain. From 56 patients, five cases were ultimately excluded, because the histological diagnosis was other than cystic ovarian endometriosis (2 teratomas and 3 haemorrhagic cysts). The mean thrombospondin-1 serum levels in group A was 256,69 pg/ml_+37,07 and in group B was 291,41 pg/ml + 35,59. Pain symptoms in ovarian endometriosis is not correlated with thrombospondin-1 serum levels.
    Journal of Ovarian Research 11/2009; 2(1):18. · 2.43 Impact Factor
  • Manuel García Manero, Juan Luis Alcazar
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    ABSTRACT: To determine whether interleukin-8 (IL-8) serum levels are correlated with pelvic pain in patients with ovarian endometriomas. Prospective study. Tertiary-care university hospital. Interleukin-8 serum levels were prospectively analyzed in 51 patients (group A, asymptomatic patients or patients with mild dysmenorrhea; group B, severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists between IL-8 serum levels and pelvic pain. Interleukin-8 serum levels determination. Interleukin-8 serum levels and pelvic pain. From 56 patients, five cases were ultimately excluded because the histologic diagnosis was not cystic ovarian endometriosis (2 teratomas and 3 haemorragic cysts). The mean (+/-SD) IL-8 serum levels in group A were 6.41 +/- 12.17 pg/mL and in group B were 6.52 +/- 8.73 pg/mL. Pain symptoms in ovarian endometriosis is not correlated with IL-8 serum levels.
    Fertility and sterility 06/2009; 94(2):450-2. · 3.97 Impact Factor
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    ABSTRACT: An imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation. A 33-year-old woman (G3, P3) presented referring intense dysmenorrhea and intermenstrual spotting since her third cesarean delivery, 1 year before. A cesarean section dehiscence with utero-peritoneal fistula was diagnosed by transvaginal ultrasound. We can conclude that transvaginal two-dimensional power Doppler and three-dimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.
    Journal of Medical Case Reports 02/2009; 3:42.
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    ABSTRACT: Endometriosis is a common gynaecological disease of unknown aetiology. Angiogenesis appears to be one of the processes involved in its pathogenesis. Angiogenic factors are increased in the peritoneal fluid of patients with endometriosis (McLaren 1996 et al; Taylor et al, 2002), in peritoneal implants (Ferriani et al, 1993) and in ovarian endometriomas. On the other hand, some researchers have found that angiogenesis is related to pelvic pain. We speculated that ovarian endometriomas in patients presenting with pelvic pain would be more angiogenic than those in asymptomatic women and that their vascular features would therefore be different.
    Revista de medicina de la Universidad de Navarra 01/2009; 53(2):8-13.
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    ABSTRACT: The prevalence of pelvic endometriosis is high, affecting approximately 6% to 10% of women of reproductive age. Although endometriosis has been associated with the occurrence of menstrual cycles, it can affect between 2% to 5% of postmenopausal women. We present a case of ovarian endometriosis in a 62-year-old Spanish Caucasian woman with no previous use of hormonal therapy and no history of endometriosis or infertility. ALTHOUGH THE REPORTED SITUATION IS RARE, IT IS IMPORTANT TO BE AWARE OF ENDOMETRIOSIS AFTER THE MENOPAUSE: post-menopausal endometriosis confers a risk of recurrence and malignant transformation.
    Journal of Medical Case Reports 01/2009; 3:135.
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    ABSTRACT: Endometriosis is a common gynaecological disease of unknown aetiology which affects an estimated 10% to 15% of all premenopausal women. It is defined as the presence of endometrial tissue, consisting of both glandular epithelium and stroma, outside the uterine cavity. Three different clinical entities of endometriosis can be distinguished: peritoneal endometriosis, ovarian endometriosis and deep invasive endometriosis. There are several theories to explain their pathogenesis: metaplasia of the mesothelium, in situ development of Müllerian remnants in the rectovaginal area (deep-invasive lesions) or retrograde transplantation of shed menstrual effluent (peritoneal implants). The most widely accepted hypothesis for the development of endometriosis is retrograde menstruation. However, some other factor renders certain women susceptible to the implantation and growth of this ectopic endometrium.
    Revista de medicina de la Universidad de Navarra 01/2009; 53(2):4-7.
  • B Olartecoechea, M García Manero, P Royo, M Aubà
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    ABSTRACT: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.
    Revista de medicina de la Universidad de Navarra 01/2009; 53(3):12-4.
  • Donald School Journal of Ultrasound in Obstetrics & Gynecology. 01/2009;
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    ABSTRACT: La asociación de cáncer de mama y embarazo se defi ne como la aparición de un tumor maligno mamario en la gestación o durante el primer año posparto. La frecuencia global oscila entre el 0.2 al 3.8% del total de los tumores malignos de la mama. El cáncer de mama se diagnostica, por término medio en 1 de cada 3000 gestaciones. Esta asociación plantea múltiples interrogantes y para su correcto tratamiento es necesario conocer una serie de aspectos generales, así como evaluar la repercusión que tienen los distintos esquemas de tratamiento oncológico sobre el embarazo y poder ofrecer secuencias terapéuticas aceptables y efi caces. A continuación se realiza una puesta al día de todos estos aspectos. 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 confl ict 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 institution.
    Revista de medicina, Vol. 52, Nº. 1, 2008, pags. 18-24. 01/2008;
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    ABSTRACT: Adecuate surgical treatment is mandatory in order to achieve cure in patients with breast cancer. Breast surgeons have to choice the best surgical technique over the breast and over the axillary nodes. Two new surgical aproaches have been implemented in the last decade: oncoplastic conservative surgery and sentinel lymph node biopsy. Oncoplastic surgery provides oncologic safety results and good cosmetic outcome. In this paper the technical steps and indications of different oncoplastic techniques in conservative breast surgery are review. Concerning to axillary surgery sentinel lymph node biopsy is the gold standard. However there are several controversial points in sentinel node biopsy referring to indications, identifi cation and histological fi ndings. Un tratamiento quirúrgico correcto es imprescindible para conseguir la curación de las pacientes con cáncer de mama. El cirujano debe elegir la mejor cirugía tanto en la mama como en los ganglios axilares. En la última década se han incorporado dos nuevas técnicas quirúrgicas: la cirugía oncoplástica conservadora y la biopsia de ganglio centinela. La cirugía oncoplástica aporta seguridad oncológica y buen resultado estético. En este trabajo se revisan los pasos técnicos y las indicaciones de las diferentes técnicas oncoplásticas que se emplean en cirugía conservadora de mama. Respecto a la cirugía axilar, la biopsia de ganglio centinela es la técnica de elección actual. Sin embargo existen aspectos controvertidos en la biopsia del ganglio centinela respecto a indicaciones, técnicas de identifi cación y hallazgos histológicos.
    Revista de medicina, Vol. 52, Nº. 1, 2008, pags. 51-55. 01/2008;
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    ABSTRACT: Although needle-wire localization is the most commonly used localization technique for nonpalpable breast lesion biopsy, the technique of radioguided occult lesion localization (ROLL), is becoming increasingly used for open-surgery diagnosis in such cases. Sentinel lymph node biopsy(SLNB) is based on the hypothesis that lymphatic drainage from a tumor reaches the sentinel node(SLN) first and that it can be identified accurately and removed. If SLN exactly reflects the lymph-node status, a negative SLN for metastasis might allow complete axillary lymph node dissection (ALDN) to be avoided.
    Revista de medicina de la Universidad de Navarra 01/2008; 52(1):13-7.
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    R. Galván, C. Laparte, M. García‐Manero, J. Mazaira, J. L. Alcazar
    Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):406 - 407. · 3.56 Impact Factor
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    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 03/2007; 26(2):261-5. · 1.40 Impact Factor
  • J. L. Alcázar, M. García‐Manero, C. Laparte
    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):380 - 381. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):507 - 507. · 3.56 Impact Factor
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    J. L. Alcazar, M. Garcia‐Manero, C. Laparte, M. Jurado
    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):507 - 508. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2005; 26(4):349 - 349. · 3.56 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements. Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9 degrees rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability. Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88). Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2005; 24(8):1091-8. · 1.40 Impact Factor
  • Juan Luis Alcázar, Luis T Mercé, Manuel García Manero
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    ABSTRACT: The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses. Forty-five women (mean age, 52.3 years; range, 17-82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case. Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162). Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2005; 24(5):689-96. · 1.40 Impact Factor
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    ABSTRACT: El diagnóstico diferencial de los tumores de ovario sigue siendo un reto importante para el ginecólogo. Un diagnóstico preciso es de suma importancia para una correcta planificación de la conducta a seguir. Dicho diagnóstico diferencial se basa en los datos clínicos de la paciente, la sintomatología que presenta, la exploración física y, fundamentalmente, en la ecografía bidimensional. Recientemente se ha incorporado una nueva tecnología: la ecografía tridimensional. Esta técnica permite una mejor evaluación morfológica y un análisis más detallado de la vascularización tumoral. En el presente artículo se revisan las indicaciones que puede tener la ecografía tridimensional en la evaluación de los tumores de ovario.
    Revista de medicina, Vol. 49, Nº. 4, 2005, pags. 23-27. 01/2005;