Surgical treatment of multiple intracardiac and pulmonary artery tumor implants embolic from uterine intravascular leiomyomatosis

Intravenous uterine leiomyomatosis is the invasion of the para-uterine veins by bundles of benign uterine muscle. These muscle bundles can grow and extend directly to pelvic organs or embolize to the right cardiac chambers or pulmonary artery. We report a patient who presented with two large mobile atrial masses that were seen on echocardiography. She was treated by excision of a 18cm mass from the right atrium, two masses from the right ventricle and a huge mass from the pulmonary artery. The tricuspid valve that was rendered insufficient, was repaired by the creation of PTFE neo chordae. Two weeks later a massively enlarged uterus, ovaries, a paracolic and three intraluminal masses in the inferior vena cava were removed. The patient recovered well. One year after surgery she was asymptomatic and no masses are seen in her echocardiogram. The tricuspid valve was competent. Patients presenting with cardiac tumors from intravenous uterine leiomyomatosis must undergo aggressive surgical management to achieve a cure. We recommend a two stage (thoracic and abdominal) approach.

El índice colposcópico combinado (ICC) como método diagnóstico en la infección por papilomavirus humano y la neoplasia intraepitelial cervical / The combined colposcopic index (CCI) as a diagnostic methol in human papillomavirus infection and cervical intraepithelial neoplasia

Estudio prospectivo, comparativo en 142 pacientes del índice colposcópico combinado según al criterio de Reid y el índice empleado en la clínica de colposcopia del hospital de Ginecoobstetricia "Luis castelazo Ayala" del IMSS. Se estudiaron 72 pacientes con el índice del hospital y 70 con el ICC. Este constituido por la nitidez de los bordes periféricos, el color, características de los vasos y tinción con yodo; dándole una puntuación de 0,1,2, los cuales una vez sumados dieron una calificación final la cual se traspoló a un diagnóstico colposcópico. El ICC correlacionó con el diagnóstico histológico en 64 pacientes (91.42 por ciento) mientras que para el índice que empleamos sólo fue en 61 casos (84.7 por ciento). Los índices mostraron buena sensibilidad (0.95), un alto valor predictivo positivo (0.95 vs 0.88) una adecuada exactitud (0.91 vs 0.84) así como una buena prevalencia (0.90 vs 0.85). se concluye que el ICC es confiable para el diagnóstico colposcópico de papilomavirus humano y de la NIC.