Assessment of cervical involvement in endometrial carcinoma by hysteroscopy and directed biopsy.

The objective of this study was to assess the diagnostic validity of hysteroscopy and directed biopsy for assessing cervical involvement in endometrial carcinoma. We conducted a study of 240 hysteroscopies and 44 cervical biopsies performed on 240 patients with endometrial carcinoma between 2000 and 2005. Hysteroscopy results suggested cervical involvement in 55 cases, of which only 31 were confirmed (a subtotal hysterectomy was performed in two cases, and the resection margins were examined for tumor invasion). In the 31 patients with confirmed cervical involvement, 19 of the hysteroscopy-directed biopsies were positive, 3 were negative, and 3 provided insufficient material. Six patients did not undergo biopsy. In the 24 patients with hysteroscopy false positive, 10 directed biopsies were positive and 9 were negative. Five patients did not undergo biopsy. Hysteroscopy suggested an absence of cervical involvement in 185 patients. Diagnosis was confirmed in 177 cases, and there were eight false negatives. In our case, office hysteroscopy proved to be a valid means of ruling out cervical involvement in endometrial carcinoma. However, it was not a valid means of detecting tumor involvement, even when combined with directed biopsy.

Dieta cetogénica en epilepsia refractaria: eficacia, evolución y complicaciones a largo plazo / Ketogenic diet in refractory epilepsy: efficacy, evolution and long-term complications

Background: Ketogenic diet (KD) represents an alternative in treatment of refractory epilepsy (RE). Objective: To evaluate the efficacy of the diet and the frequency of complications in patients belonging to the KD Program from Luis Calvo Mackenna Children's Hospital (HLCM). Methods: Evaluation of all children enrolled in the program between 1999 and 2004, with analysis every 6 months of the diet efficacy, digestive tolerance, nutritional status, cholesterol levels and nephrolithiasis. Results: 21 children were admitted, 14 boys, age between 6 months - 17 years-old. 76 percent, 71 percent and 67 percent of patients followed KD at 6, 12 and 18 months, respectively, with KD efficacy of 67 percent. At 12 months, 24 percent of patients did not present seizures. At 18 months, 85 percent remained close to ideal body weight (15 percent obesity) and height/age Z score decreased (-0,7 +/- 0,4; p < 0,05). Total cholesterol significantly increased at 6 months (64 percent hypercholesterolemia; decreased to 15 percent at 18 months). 2 patients developed nephrolithiasis. Conclusions: The study shows high efficacy of the KD for treatment of refractory epilepsy, with low rate of complications. It should be considered as a therapeutic alternative for these patients.

La dieta cetogénica (DK) es una opción de tratamiento en epilepsia refractaria (ER). En Chile no hay estudios publicados al respecto. Objetivo: Evaluar la eficacia de la dieta en el control de las convulsiones y la frecuencia de complicaciones en los pacientes del programa de DK, para el tratamiento de ER, del Hospital Luis Calvo Mackena (HLCM). Pacientes y Método: Evaluamos todos los niños ingresados al programa entre 1999-2004. Para efectos de este trabajo se consideró el control al ingreso y cada 6 meses, evaluándose: eficacia de la dieta, tolerancia digestiva, evolución nutricional, niveles de colesterol plasmático y litiasis renal. Resultados: Ingresaron 21 niños de 6,2 años (6 meses a 17 años), 14 de sexo masculino. A los 6, 12 y 18 meses, 76 por ciento, 71 por ciento y 67 por ciento de los pacientes, respectivamente, se mantenía en dieta. La eficacia del tratamiento fue 67 por ciento. A los 12 meses, 24 por ciento de los pacientes estaba sin crisis. A los 18 meses 85 por ciento de los pacientes estaba eutrófico y 15 por ciento obeso. Se observó deterioro en la talla (delta zT/E -0,7 +/- 0,4; p < 0,05). El colesterol total aumentó significativamente a los 6 meses, encontrándose el 64 por ciento hipercolesterolémico; a los 18 meses este porcentaje se redujo a 15 por ciento. Dos pacientes presentaron litiasis renal (9 por ciento). Conclusiones: Este estudio muestra una muy buena eficacia de la dieta cetogénica para el tratamiento de la epilepsia refractaria, y una baja frecuencia de complicaciones, por lo que debería ser considerada como alternativa terapéutica en estos pacientes.

Fascitis necrotizante: complicación de una episiotomía. Caso clínico y revisión de la bibliografía / Necrotizing fasciitis as a complication of episiotomy. Case report and literatura review

La fascitis necrotizante es una complicación infecciosa infrecuente en ginecología y obstetricia, pero está asociada a una alta morbilidad y mortalidad. Un diagnóstico precoz y un tratamiento quirúrgico rápido y agresivo son esenciales para mejorar la supervivencia. Se han identificado muchos factores de riesgo, sin embargo, en pacientes obstétricas no parece haber factores predisponentes, salvo el propio estado del embarazo

Necrotizing fasciitis is an infrequent infectious complication in gynecology and obstetrics but is associated with high morbidity and mortality. Early diagnosis and prompt aggressive treatment are essential to improve survival. Many risk factors have been identified. However, obstetric patients do not seem to have predisposing factors apart from pregnancy itself

Resección endometrial en el tratamiento de la hemorragia uterina disfuncional / Endometrial resection in the treatment of dysfunctional uterine bleeding

Objetivos: Analizar la efectividad de la resección endometrial como tratamiento de la hemorragia uterina disfuncional. Pacientes y método: Se incluyen 100 pacientes con hemorragia uterina disfuncional en quienes se realiza resección endometrial. Se mide el éxito terapéutico (desaparición o mejoría de la sintomatología) y el grado de satisfacción de las pacientes (encuesta). Resultados: Se obtuvo un porcentaje de éxito del 82 per cent con un grado de satisfacción del 76 per cent. Conclusión: La resección endometrial es una alternativa a la histerectomía que puede ofrecerse a pacientes pre-perimenopáusicas en quienes ha fallado el tratamiento médico. (AU)

[Analysis of emergency referrals to dermatology]. / Análisis de las derivaciones urgentes a dermatología.

OBJECTIVE: To analyse the urgent consultations sent by doctors to a Dermatology Department for origin, reason for referral, clinical compliance, suspected diagnosis, concordance with the dermatologist's diagnosis and justification of the urgent referral. DESIGN: Descriptive study. SETTING: The information was gathered in the tertiary specialist Dermatology service of Navarra, which covers the whole population. PARTICIPANTS: Of the total (595) number of urgent forms received by the service in 1995, 505 were analysed and contrasted with the dermatological clinical history. Each patient corresponded to a form. MEASUREMENTS AND MAIN RESULTS: The following was analysed: age, sex, origin of referral, reason for referral, clinical compliance, suspected diagnosis, concordance with the dermatologist's diagnosis and justification of the urgent referral. Most letters came from Health Centres (48.5%). The most commonly alleged reason for referral was diagnostic help (51.2%). There was good clinical compliance only in the notes coming from hospital Casualty Departments (78.7%). CONCLUSIONS: There were major deficiencies in all the points under analysis, with no significant differences as to origin, except for hospital Casualty, which had better clinical compliance and whose referrals were more justified.

Comparison of the efficacy and tolerability of dexketoprofen and ketoprofen in the treatment of primary dysmenorrhea.

Dexketoprofen, the pure S(+)-enantiomer of ketoprofen, is a promising new analgesic, but few clinical trials have yet examined its efficacy and tolerability. In this study, patients with a history of primary dysmenorrhea were treated with dexketoprofen doses of 12.5 and 25 mg, ketoprofen 50 mg, and placebo using a randomized, four-way crossover design. Efficacy analyses showed that dexketoprofen 12.5 and 25 mg and racemic ketoprofen 50 mg significantly reduced pain intensity compared with placebo from 1 h after dose to 4-6 h after dose. Interestingly, dexketoprofen at 12.5 mg was significantly superior to placebo at 30 min after dose. Mean pain relief scores also demonstrated that both doses of dexketoprofen and racemic ketoprofen were significantly superior to placebo at 1-6 h after the first dose. No indices of analgesic efficacy showed any significant differences between the two doses of dexketoprofen or between dexketoprofen and ketoprofen. After repeated dose administration, similar results were obtained. There were no significant effects of any treatment on activities of daily living, menstrual flow, or associated symptoms. Dexketoprofen was effective, well tolerated, and had no difference in the incidence of adverse events compared to ketoprofen or placebo.

[Utilization of an emergency service by patients with HIV infection]. / Utilización de un servicio de urgencias por pacientes con infección por VIH.

BACKGROUND AND METHODS: To know the impact of HIV infection in a hospital emergency department the health care episodes of seropositive individuals are reviewed in a retrospective study from the January 1 to March 31, 1992. Cases have been identified comparing the list of those infected by HIV with the users of the department during the period studied. RESULTS: 430 episodes in 288 patients (1.5 episodes/patient) have been included constituting 2.3% of the total. 76.4% were males, with a mean age of 29.2 years (range, 18-59) and 60.2% were evaluated the medical area. Hospital admission was indicated on 147 occasions (34.2% versus 19% of seronegatives; p < 0.001). The most frequent diagnoses were infections which were or were not associated to alteration of cellular immunity (32.8%) and complications related with the abuse of opioid substances (23.7%). CONCLUSIONS: The pathology associated to HIV infection and to the abuse of intravenous drugs constitutes a frequent problem in the emergency departments. The infectious diseases which are or are not associated to alteration in cellular immunity, complications related with the consumption of opioids and the high index of admissions are of note. Professionals carrying out health care work in this medium must be familiarized with the diagnosis and treatment of these processes.

[The long-term record card, instrument for evaluating prolonged treatments]. / La cartilla de largo tratamiento, instrumento de evaluación de los tratamientos prolongados.

OBJECTIVE: To find out the quality of extended treatments as recorded on the long-treatment medical record cards of the users of Chantrea Health Centre (Pamplona). DESIGN: This was a descriptive crossover study. SITE. An urban Primary Care centre. PATIENTS OR OTHERS PARTICIPANTS: The record cards filled in by registered nurses and physicians during one week in May 1990 were chosen. No prior notice was given to the rest of the team. Overall, 370 record cards were studied. MAIN MEASUREMENTS AND RESULTS: The average of drugs per person is 2.93 + 1.81, with significant differences for those over 65 years old (p less than 0.01). Regarding the quality indicators used: 78% of the medicines are included in the Primary Care Guide; 79.5% of those studied only took one drug; drugs were administered orally in 83% of cases; occasional concomitant medication was detected on 22.7% of the record cards and potential interactions existed on 35% of the cards. CONCLUSIONS: A therapeutic level, which was acceptable in terms of the indicators used, was supposed. For the Primary Care team to reflect jointly on prescriptions was thought to be important. The question was posed of a training programme for all doctors working in the area.

[Colorectal cancer: detection using the guaiac test at a primary care center]. / Cáncer colorrectal: detección mediante la preuba del guayaco en un centro de atención primaria.

BACKGROUND: Colorectal cancer constitutes a serious health care problem in the Western world due to its frequency and mortality. Early detection and strict follow up of disease with risk of degeneration may increase survival. The guaiac test for fecal occult blood detection (one of the first signs of cancer) may contribute to the aforementiokned. METHODS: The guaiac test was randomly offered to patients consulting in general medicine. Those who accepted were taken to group meeting in general information and the test. Patients with positive tests underwent colonoscopy. Patients delaying the conclusion of the study were remained by telephone. Participation and the lesions detected were evaluated. RESULTS: The test was offered to 1,605 subjects, of whom 1,334 attended the meetings and 1,166 completed the test. Sixty patients were found to be positive and 52 underwent colonoscopy. The most significant diagnosis were 5 carcinomas at different stages and 25 neoplastic polyps. One hundred seventy-eight people were recouperated from 481 telephoned. CONCLUSIONS: The high participation in this study concerning early detection and follow up of disease with risk of degeneration to colorectal carcinoma is emphasized, in addition to the good response to the use of the telephone. Moreover, the low rejection to colonoscopy and the important lesions detected during this study are also of note.

Epirubicin: clinical toxicity during the phase II program in endometrial and cervical cancer.

We have evaluated the clinical toxicity of Epirubicin 80 mg/m2 i.v., every 3 weeks in 58 patients with FIGO III-IV endometrial adenocarcinoma or squamous uterine cervix carcinoma. The median age of the whole group was 59 years (37-77); 37 patients were previously treated with radiotherapy and two with cisplatin based chemotherapy. The median KI at entry was 80. A total of 308 courses of chemotherapy were administered with a median of 5 per patient. Overall toxicity data shows that this dose level is associated with mild haematological toxicity with only two cases having grade 3 (WHO) leukopenia. Nine patients suffered emesis in spite of prophylactic therapy and were classified as grade 3. One case presented grade four diarrhoea but the relation with the antineoplastic treatment was uncertain. One woman with hepatic dysfunction at entry had grade 3 leukopenia, developed pneumonia and died. The median total cumulative dose of EPI was 360 mg/m2 (160-880) with 19 cases exposed to cumulative doses higher than 550 mg/m2. Congestive heart failure was not observed. Our data confirm the safety of EPI at these dose levels and suggest the possibility of developing new trials with higher doses of this anthracycline analog.

Single agent epirubicin in squamous cell cervical cancer. A phase II trial.

Thirty consecutive patients with FIGO stage III-IV, squamous cell uterine cervix cancer were entered in a phase II trial evaluating activity and safety of epirubicin when given at a dose of 80 mg/m2 i.v., every 3 weeks. Two complete responses (including a pathological complete remission) plus 3 partial responses were observed among 27 evaluable patients with a response rate of 18.5% (95% confidence limits = 7.6%-36.4%). The median time to progression and median survival for all treated patients were 3 and 8 months respectively. Treatment was well tolerated. Haematological toxicity was mild. WHO grade 4 toxicity was not observed. The median total cumulative dose of epirubicin was 360 mg/m2 (80-840 mg/m2). Congestive heart failure was not noted. Further studies in cervical cancer with higher doses of epirubicin as single agent or in combination with other nonmyelotoxic drugs are indicated.