MVA E2 recombinant vaccine in the treatment of human papillomavirus infection in men presenting intraurethral flat condyloma: a phase I/II study.

BACKGROUND: Human papillomavirus (HPV) is the etiologic agent for warts and cervical cancer. In Mexico, the death rate from cervical cancer is extremely high, and statistical data show that since 1990 the number of deaths is increasing. Condylomas and cancer of the penis are the most common lesions presented in men; bladder and prostate cancer in men are also associated with the presence of HPV. Since HPV is transmitted by sexual intercourse, treating both partners is necessary in order to eliminate the virus in the population. Approaches to this include preventative vaccines such as Gardasil, and therapeutic vaccines to treat established infections in both men and women. This will be the only way to decrease the numbers of deaths due to this malignancy. PATIENTS AND METHODS: We conducted a phase I/II clinical trial to evaluate the potential use of the recombinant vaccinia viral vaccine MVA E2 (composed of modified vaccinia virus Ankara [MVA] expressing the E2 gene of bovine papillomavirus) to treat flat condyloma lesions associated with oncogenic HPV in men. Fifty male patients with flat condyloma lesions were treated with either MVA E2 therapeutic vaccine or fluorouracil (5-fluorouracil). Thirty men received the therapeutic vaccine, at a total of 10(6) virus particles per dose, administered directly into the urethra once every week over a 4-week period. Twenty control patients were treated with 5% fluorouracil 1mL twice weekly over a 4-week period directly into the urethra. Reduction of lesions or absence of papillomavirus infection was monitored by colposcopy and histologic analysis. The immune response after MVA E2 treatment was determined by measuring the antibodies against the MVA E2 virus and by analyzing the lymphocyte cytotoxic activity against cancer cells bearing oncogenic papillomavirus. Presence of papillomavirus was determined by the Hybrid Capture method. RESULTS: Twenty-eight of 30 patients showed no lesion or presence of papillomavirus as diagnosed by colposcopy and brush histologic examination after 4 weeks of MVA E2 treatment. These patients showed complete elimination of flat condyloma in the urethra and no acetowhite spots were detected over the prepuce. In two other patients the acetowhite spots and flat condyloma did not diminish. All patients developed antibodies against the MVA E2 vaccine and E2 protein, and generated a specific cytotoxic response against papilloma-transformed cells. Viral DNA was not detected in MVA E2-treated patients. In the control group, 13 of 20 patients were free of lesions. Three of these patients had recurrence of lesions after 3 months of treatment and none of the patients developed specific antibodies against cancer cells. In contrast, patients treated with MVA E2 did not show any recurrence of lesions after 1 year of treatment. In addition, none of the patients had local or systemic adverse effects according to the WHO classification 1-4. CONCLUSIONS: Therapeutic vaccination with MVA E2 proved to be very effective in stimulating the immune system against papillomavirus, and in generating regression of flat condyloma lesions in men.

Análisis del nivel de empatía en un curso de quinto año de medicina, a través de una escala validada para este efecto / Analysis of level empathy in fifth grader medicine students, through falidated scale

La empatía es un concepto amplio y en la literatura se pueden encontrar múltiples definiciones. El aspecto cognitivo de la empatía se refiere la habilidad para entenderlas experiencias y sentimientos de la otra persona y la capacidad de ver el mundo desde la perspectiva del otro. Se ha demostrado que la empatía presente en el personal de salud otorga ventajas. Por ejemplo, mejora la satisfacción del paciente, aumenta la complacencia, incrementa la habilidad del médico en el diagnóstico y tratamiento y baja significativamente el riesgo de juicio por mala práctica. El objetivo del presente trabajo es implementar la escala de empatía denominada“The Jefferson Scale of Physician Empathy” en un curso de alumnos de medicina del HCUCh y realizar un análisis descriptivo del grado de empatía presente, según sexo y especialidad a seguir. Las mujeres obtuvieron un puntaje mayor de empatía con respecto a los hombres. Se encontraron diferencias en el grado de empatía según la especialidad a seguir del estudiante. El análisis estadístico no mostró que estas diferencias fueran significativas.

The empathy is a wide concept and in literature there are many definitions. Thecognitive aspect of the empathy talks about the ability to understand the experiences and feelings of the other person and the capacity to see the world from the perspective of the other. It has been shown that empathy foster patient’s satisfaction, improve compliance, increase physician’s ability to properly diagnose and reducesrisk of malpractice. The objective of the present work is to implement “TheJefferson Scale of Physician Empathy ” in a medicine course of the HCUCh and make a descriptive analysis ofthe degree of empathy, according to sex and speciality to follow. The women tend to score higher on empathy rating than men. Differences were found in the empathy degree of the students according to the speciality they follow. No statistical differences were found in both cases.

Complications of operative gynecological laparoscopy.

OBJECTIVE: To assess the incidence and type of laparoscopic complications. METHODS: A series of 2140 operative laparoscopies were reviewed in a retrospective study of patient records. The setting was a tertiary-care university hospital. Operative laparoscopy included minor procedures (minimal adhesiolysis, destruction of minimal endometriosis foci, ovarian biopsy, ovarian puncture, tubal sterilization), major laparoscopic surgery (extended adhesiolysis, tuboplasties, uterine suspension, treatment for ectopic pregnancy, salpingitis, ovarian cyst, moderate and severe endometriosis), and advanced laparoscopic surgery (hysterectomy, myomectomy, bladder neck suspension). RESULTS: Two major vascular complications, 3 intestinal injuries, 1 anesthesiological complication, and 4 urinary tract injuries occurred. Two minor and 5 postoperative complications were noted. The overall complication rate was 17/2140 (0.79%). The major complication rate was 10/2140 (0.46%). CONCLUSIONS: This review is useful for helping surgeons reduce the risk of injuries and to inform patients about potential complications. These rates are similar to those that have been previously reported.

Complicaciones en histeroscopía / Hysteroscopy complications

La histeroscopía, procedimiento con fines diagnósticos y terapéuticos, permite una visión directa de la cavidad uterina. Es relativamente sencilla, pero no exenta de complicaciones, reportándose en la literatura mundial cifras variables entre 0,95 y 25 por ciento. Se realizó un estudio retrospectivo de los procedimientos histeroscópicos ejecutados entre el 1º de mayo de 2000 y el 31 de julio de 2001 en el Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile. Se registró en cada paciente la edad, paridad, patología uterina que justificó el procedimiento, tipo de operación practicada, operador y presencia de complicación. Se realizaron 120 procedimientos histeroscópicos en el período definido, encontrándose tres perforaciones uterinas, siendo ésta la única complicación encontrada, lo que corresponde a un 2,5 por ciento del total, cifra que está acorde a la literatura mundial. Los autores concluyen que la histeroscopía constituye un buen método de diagnóstico y tratamiento para la patología intrauterina, poco invasiva, de alto rendimiento, bajo costo, rápida, pero no exenta de riesgos, lo que amerita un adiestramiento adecuado

Diagnóstico y tratamiento antenatal de taquicardia supraventricular fetal / Antenatal diagnosis and treatment of fetal supraventricular tachicardia

Presentamos un caso clínico de taquicardia supraventricular fetal complicado con hidrops fetalis diagnosticado a las 27 semans de gestación por medio de ecocardiografía fetal. Se realizó tratamiento in utero con digitálicos por vía materna con remisión de la TSV y del hidrops fetalis. A las 34 semanas se obtiene un RN sano con control electrocardiográfico continuo normal