Nanoporosity, Inclusion Chemistry, and Spin Crossover in Orthogonally Interlocked Two-Dimensional Metal-Organic Frameworks.

[Fe(tvp)2 (NCS)2 ] (1) (tvp=trans-(4,4'-vinylenedipyridine)) consists of two independent perpendicular stacks of mutually interpenetrated two-dimensional grids. This uncommon supramolecular conformation defines square-sectional nanochannels (diagonal≈2.2 nm) in which inclusion molecules are located. The guest-loaded framework 1@guest displays complete thermal spin-crossover (SCO) behavior with the characteristic temperature T1/2 dependent on the guest molecule, whereas the guest-free species 1 is paramagnetic whatever the temperature. For the benzene-guest derivatives, the characteristic SCO temperature T1/2 decreases as the Hammet σp parameter increases. In general, the 1@guest series shows large entropy variations associated with the SCO and conformational changes of the interpenetrated grids that leads to a crystallographic-phase transition when the guest is benzonitrile or acetonitrile/H2 O.

Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.

Laparoscopic treatment of genitourinary fistulae.

We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail. Timing of repair is often individualized mainly according to the etiology, delay of diagnosis, size of fistula, the first or subsequent repairs, and the general condition of the patient. Different surgical techniques for the management of RUF have been reported. Encouraged by our experience in minimally invasive surgery we present the laparoscopic approach.

Tratamiento laparoscópico de fístulas genitourinarias / Laparoscopic treatment of genitourinary fistulae

Presentamos el manejo laparoscópico de fístulas genitourinarias, principalmente cinco tipos de fístulas, vesico-vaginal, uretero-vaginal, vesico-uterina, recto uretral y recto vesical. La fístula vesico-vaginal (FVV) es secundaria principalmente a procedimientos de uroginecología en los países desarrollados, siendo la principal causa de esta enfermedad la histerectomía abdominal, que representa un 84,9% de las fístulas genitourinarias (1). Se ha publicado el bajo índice (7-12%) de éxito en el manejo de este tipo de fístula. Las fístulas uretero-vaginales pueden presentarse después de cirugía pélvica, especialmente procedimientos ginecológicos, o como resultado de cuerpos extraños en la vagina o fragmentos litiásicos residuales después de la litotricia. Estos pacientes presentan típicamente pérdidas globales y persistentes de orina a través de la vagina, esto provoca molestias y angustia al paciente, el tratamiento inicial es conservador, pero a menudo insuficiente. La fístula vesico-uterina es una enfermedad rara que sólo ocurre entre el 1 al 4% de las fístulas genitourinarias, la causa principal es la cesárea del segmento bajo. Se presenta clínicamente de tres formas diferentes, que se describirán. El tratamiento de este tipo de fístulas ha sido conservador, con la terapia hormonal y cirugía, dependiendo de los síntomas presentes. Las fístulas recto urinarias (recto vesical y recto uretral) (FRU) son poco comunes y pueden ser difíciles de manejar clínicamente. A pesar de que se pueden desarrollar en pacientes con enfermedad inflamatoria intestinal y abscesos peri rectales, las fístulas recto uretrales se producen con frecuencia como una complicación iatrogénica de procedimientos de próstata. La fístula recto vesical generalmente se desarrolla después de prostatectomía radical, y se produce a lo largo de la línea anastomótica vesico-uretral o a lo largo de la línea de sutura de un cierre posterior (raqueta posterior) de la vejiga (...) (AU)

We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder (...) (AU)

Factores psicosociales relacionados con la calidad de vida en salud en pacientes hemodializados / Psychosocial factors linked to health related quality of life in hemodialysis patients

Objetivo: analizar la relación existente entre las variables edad, tiempo en tratamiento, sexo, apoyo familiar percibido, salud mental, estado de salud percibido y la calidad de vida (CV) Método: Se evaluaron 128 pacientes del Hospital Clínico Regional y de un Centro de diálisis privado, ambos de la ciudad de Antofagasta. Se utilizó el cuestionario específico para CV en enfermedad renal KDQOL-36 Õ y los instrumentos Apgar Familiar y GHQ-28. Se analiza la relación existente entre cada dimensión de la CV evaluada y los factores mencionados. Resultados: No se encuentra relación entre la CV el tiempo viviendo con la enfermedad, como tampoco con la edad o el sexo. Las diversas dimensiones en salud mental son de las evaluadas las que presentan un mayor grado de correlación con las dimensiones de calidad de vida. Conclusiones: La salud mental es un elemento modulador de la CV, en tanto otros como el sexo, el tiempo de diálisis o la edad de los participantes no constituyeron elementos relevantes en esta evaluación.

Objective: To analyze the relationship between the variables age, time in treatment, gender, perceived family support, mental health, perceived health status and quality of life (QoL). Method: We studied 128 patients in Public Hospital and a private dialysis center, both in the city of Antofagasta. We used the questionnaire for kidney disease 36 Õ KDQOL-36 Õ, the Apgar Family and GHQ-28. We evaluated the relationship between each dimension of the QoL and the factors mentioned. Outcomes: No relationship was found between the QoL and time living with the disease, gender and age. The several dimensions of mental health is assessed to have a greater correlation with the dimensions of quality of life. Conclusions: Mental health is a modulator of the QoL, while others such as gender, length of dialysis and the age of the participants were not factors relevant to this assessment.

Bridging, terminal, free, anti and gauche BPA ligands in a 1D hybrid organic-inorganic Mn(II)-cyanate system.

A hybrid organic-inorganic chain compound of the family Mn(II)-bpa-(NCO) is presented. It contains, unusually, five different dispositions for the bpa [1,2-bis(4-pyridyl)ethane] ligand. Water molecules and free bpa ligands occupy the voids of the structure. The compound shows significant antiferromagnetic-type interactions as a consequence of different exchange pathways.

Defective dicubane-like tetranuclear nickel(II) cyanate and azide nanoscale magnets.

Four tetrameric nickel(II) pseudohalide complexes have been synthesized and structurally, spectroscopically, and magnetically characterized. Compounds 1-3 are isostructural and exhibit the general formula [Ni(2)(dpk·OH)(dpk·CH(3)O)(L)(H(2)O)](2)A(2)·2H(2)O, where dpk = di-2-pyridylketone; L = N(3)(-), and A = ClO(4)(-) for 1, L = NCO(-) and A = ClO(4)(-) for 2, and L = NCO(-) and A = NO(3)(-) for 3. The formula for 4 is [Ni(4)(dpk·OH)(3) (dpk·CH(3)O)(2)(NCO)](BF(4))(2)·3H(2)O. The ligands dpk·OH(-) and dpk·CH(3)O(-) result from solvolysis and ulterior deprotonation of dpk in water and methanol, respectively. The four tetramers exhibit a dicubane-like core with two missing vertexes where the Ni(II) ions are connected through end-on pseudohalide and oxo bridges. Magnetic measurements showed that compounds 1-4 are ferromagnetic. The values of the exchange constants were determined by means of a theoretical model based on three different types of coupling. Thus, the calculated J values (J(1) = J(2), J(3), and D) were 5.6, 11.8, and 5.6 cm(-1) for 1, 5.5, 12.0, and 5.6 cm(-1) for 2, 6.3, 4.9, and 6.2 cm(-1) for 3, and (J(1), J(2), J(3), and D) 6.9, 7.0, 15.2, and 4.8 cm(-1) for 4.

Structural analysis, spectroscopic, and magnetic properties of the 1D triple-bridged compounds [M(dca)2(bpa)] (M = Mn, Fe, Co, Zn; dca = dicyanamide; bpa = 1,2-bis(4-pyridyl)ethane) and the 3D [Ni(dca)(bpa)2]dca·6H2O.

The family of compounds [Mn(dca)(2)(bpa)] (1), [Fe(dca)(2)(bpa)] (2), [Co(dca)(2)(bpa)] (3), [Zn(dca)(2)(bpa)] (4), and [Ni(dca)(bpa)(2)]dca·6H(2)O (5), with dca = dicyanamide and bpa = 1,2-bis(4-pyridyl)ethane, has been synthesized. These compounds have been characterized by single crystal (1, 2, 4, and 5) and powder X-ray diffraction (3), by Fourier transform infrared (FTIR), UV-vis, and electron paramagnetic resonance (EPR) spectroscopies, and by magnetic measurements. Compound 1 crystallizes in the monoclinic C2/c space group, Z = 4, with a = 16.757(6), b = 9.692(3), and c = 13.073(4) Å, and ß = 123.02(2)°; Compound 2 crystallizes in the monoclinic C2/c space group, Z = 4, with a = 16.588(5), b = 9.661(3), c = 12.970(5) Å, and ß = 123.16(3)°; Compound 4 crystallizes in the monoclinic C2/c space group, Z = 4, with a = 16.519(2), b = 9.643(2), c = 12.943(2) Å, and ß = 123.15(1)°; Compound 5 crystallizes in the monoclinic C2/c space group, Z = 4, with a = 18.504(4), b = 19.802(3), and c = 8.6570(18) Å, and ß = 99.74(2)°. The compounds 1-4 are isostructural and show a one dimensional (1D) disposition, with the metal(II) ions bridged by double µ(1,5) dca ligands and unusually by a third bridge consisting of the bpa ligand, which adopts a very low torsion angle to accommodate in the structure. This kind of structure is unusual, even considering the voluminous bpa bridge. The compound 5 shows a 3D structure with layers of Ni-bpa joined by single dca bridges. Magnetic susceptibility measurements show antiferromagnetic couplings, increasing for 1-3. Compound 5 shows very slight antiferromagnetic interactions.

Prospective study of prostate cancer's detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml.

UNLABELLED: SUMMAR OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml. METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. EXCLUSION CRITERIA: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis/ Chi square, t-student and Fischer exact test. RESULTS: Twenty eight percent of the patients had positive biopsy for PCa. Fifty six percent were Gleason 6 and 44% Gleason 7. Group 1 had 59%(20) and Group 2 41% (13) in. In Group 1 16% had positive biopsy for PCa vs 46% in group 2 (p 0.04) RR 3.07. CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa.

Trinuclear nickel(II) complex through a 2,3,5,6-tetrakis(2-pyridyl)pyrazine ligand with a linear exchange pathway.

The compound [Ni(3)(tppz)(2)(NCS)(2)(H(2)O)(4)](NO(3))(4).4H(2)O [tppz = 2,3,5,6-tetrakis(2-pyridyl)pyrazine and NCS = thiocyanate ligand] consists of trimeric units, where the three Ni(II) cations are linked by two bis-tridentate tppz ligands. This compound crystallizes in the monoclinic space group C2/c, with Z = 4, a = 25.1116(12) A, b = 10.8127(5) A, c = 25.2294(13) A, and beta = 116.856(5) degrees . The crystal structure is in good agreement with the antiferromagnetic interactions because of unidirectional coupling through the tppz ligands.

Estudio prospectivo sobre la tasa de detección de cáncer de próstata en nuestro hospital en pacientes del Noroeste de México con antígeno prostático específico entre 2, 6 y 4 ng/ml / Prospective study of prostate cancer’s detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml

OBJETIVO: Encontrar la tasa de detección de Cáncer Prostático (CaP) en nuestra población con Antígeno Prostático Específico (APE) entre 2.6 y 4 ng/ml.MÉTODOS: Se incluyeron 33 pacientes consecutivos, mediana 66 años. se les realizó biopsia transrectal guiada por ultrasonido (BTR-US) con APE entre 2.6 y 4 ng/ml. Se dividieron en 2 grupos. Grupo 1: pacientes con tacto rectal (TR) normal. Grupo 2: pacientes con ligero aumento en la consistencia de la próstata. Criterios de exclusión: CaP, neoplasia intraepitelial o TR evidente de CaP. Análisis estadístico: t de student, Fischer y X2.RESULTADOS: El 28.3% (9) fue positiva para CaP. El 56% (5) presentó CaP Gleason 6 (3+3) y el 44% (4) Gleason 7 (3+4). El 59% (20) se incluyeron en el Grupo 1 y 41% en el Grupo 2. En el grupo 1 16%(3) presentaron CaP vs 46% (6) del grupo 2 (p 0.04), RR=3.07.CONCLUSIÓN: Hay indicios de que la tasa de detección del CaP en la población de estudio pueda ser menor a lo reportado en la literatura. El TR es importante en la evaluación inicial, pequeñas anormalidades incrementan 3 veces el riesgo de CaP(AU)

OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml.METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. Exclusion criteria: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis: Chi square, t-student and Fischer exact test.RESULTS: Twenty eight percent of the patients (9) had positive biopsy for PCa. Fifty six percent (5) were Gleason 6 and 44% (4) Gleason 7 (3+4). Group 1 had 59% (20) and Group 2 41% in. In Group 1 16% (3) had positive biopsy for PCa vs 46% (6) in group 2 (p 0.04) RR 3.07.CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa(AU)

Bis(2,3,5,6-tetra-2-pyridyl-pyrazine-κN,N,N)nickel(II) dithio-cyanate dihydrate.

In the title compound, [Ni(C(24)H(16)N(6))(2)](NCS)(2)·2H(2)O, the central Ni(II) ion is octahedrally coordinated by six N atoms of two tridentate 2,3,5,6-tetra-2-pyridyl-pyrazine ligands (tppz). Two thio-cyanate anions act as counter-ions and two water mol-ecules act as solvation agents. O-H⋯N hydrogen bonds are observed in the crystral structure.

Remoção de sulfato de águas residuárias industriais em reator anaeróbio de leito fixo operado em bateladas sequenciais / Sulfate removal from industrial wastewaters in fixed film anaerobic sequential batch reactor

Avaliou-se o potencial de uso reator anaeróbio operado em bateladas seqüenciais com biomassa imobilizada (ASBBR), em escala piloto, no tratamento de água residuária industrial contendo elevadas concentrações de sulfato. O ASBBR, com volume total de 1.2 m³, foi preenchido com carvão mineral como meio suporte para imobilização da biomassa (leito fixo). Foram aplicadas cargas de 0,15; 0,30; 0,65; 1,30 e 1,90 kg SO4-2/ciclo (ou batelada) com duração de 48 h, correspondendo, respectivamente, às concentrações de sulfato no afluente de 0,25; 0,50; 1,0; 2,0 e 3,0 gSO4-2.l-1. Utilizou-se etanol como doador de elétrons para a redução do sulfato. O reator foi operado à temperatura ambiente (29±8ºC), tendo sido obtidas eficiências médias na redução de sulfato entre 88 e 92 por cento em 92 ciclos (275 dias). Os resultados obtidos permitem concluir que o uso de reatores ASBBR constitui-se em alternativa eficiente para a remoção de sulfatos de águas residuárias com características semelhantes às utilizadas neste trabalho.

The potential use of an anaerobic sequencing batch biofilm reactor (ASBBR) in pilot-scale for the treatment of a sulfate-rich industrial wastewater was evaluated. The pilot 1.2 m³ ASBBR reactor was filled with mineral coal for biomass immobilization (fixed film). The sulfate loading rates applied were 0.15; 0.30; 0.65; 1.30 and 1.90 kg SO4-2/cycle (or batch). Each cycle lasted 48 h. The influent concentrations were, respectively, 0.25; 0.50; 1.0; 2.0 and 3.0 gSO4-2.l-1. Ethanol was used as electron donor for sulfate reduction. The reactor operated at ambient temperature (29±8ºC), and the mean efficiencies of sulfate removal were in the range 88 to 92 percent in the 92 run cycles. The total operating period comprised 275 days. Based on the results obtained in this research, it could be concluded that the ASBBR can be an efficient alternative for the removal of sulfate from other industrial wastewaters with similar characteristics.

Aqua-(dicyanamido-κN)(nitrato-κO,O')(2,3,5,6-tetra-2-pyridylpyrazine-κN,N,N)manganese(II).

In the title compound, [Mn(C(2)N(3))(NO(3))(C(24)H(16)N(6))(H(2)O)], the central manganese(II) ion is hepta-coordinated to a tridentate 2,3,5,6-tetra-2-pyridylpyrazine ligand (tppz), a bidentate nitrate ligand, a terminal monodentate dicyanamide ligand (dca) and a water mol-ecule. The structure contains isolated neutral complexes, which are linked by O(water)-H⋯N hydrogen bonds generating chains along [010].

[Medical treatment of unruptured ectopic pregnancy]. / Tratamiento médico del embarazo ectópico no roto.

BACKGROUND: Ectopic pregnancy is the implantation of fertilized ovum on any tissue other than the endometrial lining of the uterus. OBJECTIVE: To evaluate the effectiveness and safeness of methotrexate in the treatment of unruptured ectopic pregnancy. MATERIALS AND METHODS: From January 2000 to October 2002 five patients were diagnosed with unruptured ectopic pregnancy in Hospital Juarez de Mexico. The inclusion criteria were: hemodynamic stability, gestational sac of < 40 mm, serum beta-hCG concentration < 15,000 mIU/L and future fertility desire. Systemic methotrexate was administered as an intramuscular injection of 50 mg. Evaluation was based on transvaginal ultrasonography, beta-hCG levels and hysterosalpingography. RESULTS: Five patients with unruptured ectopic pregnancy were treated with methotrexate. Successful rate, after one or two injections, was 100% (5 patients). The size of ectopic pregnancy as estimated by ultrasonographic was 33.33 mm. Negligible plasma beta-hCG values were reached 45.6 +/- 19.85 days after the time of treatment. Ultrasonographic scanning demonstrated progressive disorganization and the gestational sac disappeared at 134 days after treatment. There were no adverse effects from the chemotherapy. In 3 of 4 women who underwent hysterosalpingography following treatment, patency of the affected tube was observed. Three women experienced an intrauterine pregnancy spontaneously in the methotrexate group. CONCLUSIONS: Systemic methotrexate treatment is safety and effective in the treatment of unruptured ectopic pregnancy, for woman with future desire of fertility and if it has unruptured, conservative treatment using methotrexate is an excellent choice.

Double-blind study to evaluate efficacy and safety of meloxicam 7.5 mg and 15 mg versus mefenamic acid 1500 mg in the treatment of primary dysmenorrhea.

OBJECTIVE: Assessment of efficacy and safety of meloxicam 7.5 mg and 15 mg once a day (o.a.d.) compared with mefenamic acid 500 mg three times a day (t.i.d.), over a treatment period of 3-5 days, during three menstrual cycles, for primary dysmenorrhea. STUDY DESIGN: Multicenter, multinational, double-blind, double-dummy, three parallel groups, randomized trial, phase IIb, 337 patients. Treatment group comparisons of continuous variables were carried out using the Kruskal-Wallis test and Wilcoxon signed rank tests. Efficacy was analyzed using Fisher and chi(2)-tests. RESULTS: Meloxicam 7.5 mg and 15 mg showed a similar profile in pain reduction and dysmenorrhea symptoms when compared with mefenamic acid. Thirty-five subjects presented with gastrointestinal (GI) adverse events (AEs). Two-thirds of those 35 subjects were in the mefenamic acid group. There were no differences between the safety profiles of the two meloxicam dosages. Laboratory abnormalities did not differ in incidence among the treatment groups. CONCLUSION: Both of the daily doses of meloxicam tested were comparable to 500 mg mefenamic acid t.i.d. in relieving dysmenorrhea symptoms, and meloxicam seems to have a better gastrointestinal tolerability profile.

Therapeutic vaccination with MVA E2 can eliminate precancerous lesions (CIN 1, CIN 2, and CIN 3) associated with infection by oncogenic human papillomavirus.

Human papillomavirus (HPV) infection is associated with cervical cancer. Papillomaviruses can induce diseases ranging from warts and condylomata to lesions that can progress to malignant neoplasias. Cervical cancer is a serious problem in developing countries because it is usually not detected at an early stage. In Mexico, a woman dies every 2 hr from this malignancy. In a phase I/II clinical trial, we evaluated the potential use of the MVA E2 recombinant vaccinia virus to treat cervical intraepithelial neoplasia CIN 1, CIN 2, and CIN 3 lesions associated with human papillomavirus (HPV) infection. Seventy-eight women with CIN 1-, CIN 2-, and CIN 3-grade lesions were treated with either an MVA E2 recombinant virus vaccine or with cryosurgery. Thirty-six women received the recombinant virus vaccine at a total of 10(7) MVA E2 virus particles injected directly into the uterus once every week over a 6-week period. Forty-two patients were treated with cryosurgery. Reduction of lesions was monitored weekly by colposcopy and cytologic analysis. The type of immune response after MVA E2 injection was determined by measuring antibody titers against MVA E2 virus and the E2 protein, and by the presence of cytotoxic activity against cancer cells bearing papillomavirus DNA. The presence of papillomavirus was determined by with the hybrid capture method. Thirty-four of 36 patients showed complete elimination of precancerous lesions after treatment with the MVA E2 vaccine. In two patients, precancerous lesions were reduced from grade CIN 3 to CIN 1. Three other patients presented isolated koilocytes after treatment with MVA E2. Colposcopy revealed no lesions in 85% of patients, and only small aceto-white spots were detected in 15% of patients after treatment with MVA E2. All patients developed antibodies against the MVA E2 vaccine, and vaccination generated a specific cytotoxic response against HPV-transformed cells. Furthermore, 50% of patients showed no evidence of papillomavirus after treatment with MVA E2, while the remaining 50% showed persistence of HPV DNA, but at approximately only 10% of the original viral load. The presence of cells cytotoxic to HPV-transformed cells, and the generation of antibodies against MVA E2, correlated with the elimination of lesions and with a remarkable reduction of HPV viral load in all patients treated with MVA E2. Additionally, the MVA E2 vaccine did not produce any apparent side effects in any of the patients treated. Cryosurgery eliminated the lesions of CIN 1 in all patients, but patients so treated did not develop cytotoxic activity against cancer cells. These results show that therapeutic vaccination with MVA E2 vaccine is an excellent prospective means for stimulating the immune system and causing the regression of precancerous CIN 1, CIN 2, and CIN 3 lesions when the vaccine is given locally.

[Surgical management of anal fistula]. / Manejo quirúrgico de la fístula anal.

UNLABELLED: Anal fistula has been known since the beginning of medical history and is defined as a duct of fibrous infected walls that runs from anal crypt to skin or rectal lumen. Internal orifice is called primary or internal, while cutaneous orifice is referred to as secondary or external. Several techniques have been developed for surgical management of anal fistula, including fistulotomy, fistulectomy with or without sphincter repair, placement of sedal cutting or seton drainage, endorectal advancement flap, and fibrin glue, among others. GENERAL OBJECTIVE: Our aim was to demonstrate the experience in management of anal fistula at the Coloproctology Unit, Gastroenterology Service, of the Mexico City General Hospital. MATERIALS AND METHODS: We conducted a retrospective, longitudinal, and descriptive study in patients with anal fistula. All patients had complete clinical and proctologic studies and pre-operative laboratory analysis. RESULTS: A total of 8,816 files were reviewed from January 1997 to December 2001; 642 (7.28%) patients were carriers of a fistula, but only 595 satisfied inclusion criteria; 500 (84.03%) were male and 95 (15.97%), female, with annual incidence of 119. Average global age was 34 years (37 years in males and 28 years in females). Age range was 17 to 80 years; most frequent decades were 31 to 40 years in 197 patients (33.11%) and 41 to 50 years in 140 patients (23.53%). Anal fistula was intersphincteric in 351 (59%) and transsphincteric in 149 (25.04%). Fistulectomy was carried out in 422 patients (70.92%), fistulotomy in 108 (18.15%), seton division in 22 (3.69%), sedal in 10 (1.68%), seton drainage in two (0.33%), endorectal advancement flap in five (0.84%), fistulectomy with sphincter repair in 14 (2.35%) patients, and in 12 (2.0%) patients it was impossible to know what type of treatment had been carried out. DISCUSSION: The fundamental aims to accomplish in treatment of anal fistula include curing, preserving anal continence, minimizing healing defects, and offering to the patient a quick recovery.

Eficácia e segurança do uso do inibidor seletivo da COX-2 versus antiinflamatório não esteróide clássico no tratamento sintomático da dismenorréia primária / Efficacy and safety of COX-2 selective inhibitor versus non selective NSAID in the symptomatic treatment of primary dysmenorrhea

Objetivo:Observação da eficácia e segurança do meloxican ( inibidor seletivo da COX-2) com ácido mefenâmico ( AINE clássico), por um periodo de três a cinco dias, durante três ciclos menstruais, para o tratamento da dismenorréia primária. Materiais e Métodos: Multicêntrico, internacional, duplo cego, paralelo, três grupos, randomizado, fase III b, 337 pacientes. AS variáveis contínuas dos grupos comparados foram analisadas através do teste de Kruskal-Wallis e Wilcoxon. Na avaliação da eficácia se utilizou o teste de Fisher e o qui-quadrado. Resultados : Meloxican 7,5 mg, 15 mg exibiu um perfil semelhante na redução da dor e dos sintomas da dismenorreia primário em comparação ao acido mefenamico. Quarenta e nove indivíduos apresentaram eventos adversos. Quase metade desses 49 pacientes eram do grupo que usou acido mefenamico. Não houve diferenças entre os perfis de segurança entre as duas dosagens de meloxican. As anormalidades laboratoriais não se diferenciaram entre os grupos estudados. Este estudo demonstrou que um AINE inibidor seletivo da COX-2 apresenta a mesma eficiência que um AINDE clássico porém com melhor perfil de tolerabilidade gastrintestinal.