Características de casos de cáncer cervicouterino: Centro Estatal de Cancerología Miguel Dorantes Mesa 2006-2010 / Characteristics of cases of cervical cancer: Centro Estatal de Cancerología Miguel Dorantes Mesa 2006-2010

Introducción En Latinoamérica uno de los problemas principales de salud pública es el cáncer del cuello uterino (CACU); México no es la excepción ya que se ha decrementado sutilmente su incidencia de esta neoplasia maligna. La mayoría de enfermas que se internan en hospitales oncológicos son casos avanzados por lo que el tratamiento no es tan eficaz como sucedería en estadios precoces. Objetivo Analizar la incidencia de CACU de las enfermas que fueron atendidas en el Centro Estatal de Cancerología (CECAN) ubicado en Xalapa, Veracruz del 1 enero del 2006 al 31 de diciembre del 2010. Las variables fueron: zona de origen, tipo histopatológico, no contar con algún tipo de seguridad social, edad, ocupación, citología cervical previa, tratamiento. Resultados Se registraron 693 casos de CACU, clasificadas en 258 pacientes rurales (37,2%), 139 suburbanas (20,1%) y 296 urbanas (42,7%). El 97,8% de enfermas se dedican a las labores domésticas. La edad media general fue de 45-49 años, zona urbana de 47,5, suburbana 49,6. El 51% no se efectuó la citología cervical, la congruencia histológica del 44%, falsos negativos 35,6%, el estadio IIB fue de más frecuente, carcinoma epidermoide 79,2%, adenocarcinoma 14%. Mayor frecuencia de tratamiento quimioterapia seguida de radioterapia. Conclusión La capacitación del personal en la toma de la muestra de citología cervical debe tener una calidad suficiente para su correcto diagnóstico y así evitar en lo posible los falsos negativos y el alto índice de infecciones cervicovaginales dificulta en gran medida el diagnóstico citológico (AU)

Introduction One of the main public health problems in Latin America is cervical cancer (CC). Mexico is no exception, since the incidence of this disease has decreased subtly. Most patients admitted to cancer hospitals have advanced disease and consequently treatment is less effective than in earlier stages. Objective To analyze the incidence of cervical cancer in patients treated at the Centro Estatal de Cancerologìa in Xalapa, Veracruz, Mexico, from January 1st, 2006 to December 31th, 2010. The variables analyzed were area of origin, histopathologic type, having no social security, age, occupation, cervical cytology, and prior treatment. Results There were 693 cases of cervical cancer classified in 258 patients from rural areas (37.2%), 139 from suburban areas (20.1%) and 296 from urban areas (42.7%). Most (97.8%) were housewives. The overall mean age was 45-49 years, 47.5 in urban areas, and 49.6 in suburban areas. Cervical cytology was not performed in 51% and histological congruence was 44%. The percentage of false-negative results was 35.6%. The most frequent stage was stage IIB. Squamous cell carcinoma accounted for 79.2% and adenocarcinoma for 14%. There was a greater frequency of chemotherapy followed by radiation treatment. Conclusion Staff should be trained to extract samples for cervical cytology of sufficient quality to allow correct diagnosis and thus avoid false negative results and the high rate of cervicovaginal infections, which hamper cytological diagnosis (AU)

Cáncer ginecológico y de la glándula mamaria en el Centro Estatal de Cancerología de Veracruz. S. S. / Gynaecological and breast cancer in the State Cancer Centre of Veracruz S. S

Actualmente, los tumores malignos ginecológicos y de la glándula mamaria son una de las principales causas de morbimortalidad a nivel mundial. Objetivo: Obtener y analizar la información a través del registro de pacientes atendidas por cáncer ginecológico y de la glándula mamaria en el Centro Estatal de Cancerología del Estado de Veracruz, México, para la orientación y monitorización de los programas de prevención, control y atención de estos tipos de cáncer en esta institución. Método: Análisis retrospectivo de pacientes atendidas por cáncer ginecológico y de la glándula mamaria, desde el 1 de enero de 1998 al 31 de diciembre del 2001; se estudió: edad, localización del tumor, variedad histológica, estadio clínico y mortalidad intrahospitalaria. Resultados: Se atendieron 1.405 pacientes con diagnóstico de cáncer ginecológico y de la glándula mamaria, con frecuencia del 60% para el cáncer de cérvix, el 20,2% de mama, el 13,4% de ovario, el 3,5% de endometrio y el 2,2% de vulva y vagina. Predominaron los carcinomas epidermoides y adenocarcinomas y más del 50% de los casos de cáncer de cérvix, mama y ovario se presentaron en estadios avanzados. Conclusión: Es importante que cada institución cuente con un registro que favorezca el acceso local de la información para definir estrategias y establecer mecanismos que permitan la toma de decisiones para mejorar los programas preventivos e impulsar la atención oportuna (AU)

Características clínicas del angiosarcoma primario de la glándula mamaria / Clinical characteristics of primary angiosarcoma of the mammary gland

Los sarcomas del tejido blando de la mama son sumamente raros (de 10,04 al 1 por ciento de todos los tumores malignos de la mama). La etiología de estas neoplasias vasculares se asocia frecuentemente al antecedente de cirugía y radioterapia. Informamos de un caso de angiosarcoma primario de la glándula mamaria y tratamos de analizar los aspectos clínicos, morfológicos, de pronóstico y tratamiento de esta enfermedad (AU)

Estudio comparativo entre cono terapéutico e histerectomía como tratamientos de la lesión escamosa del cuello uterino / A comparative study between therapeutic conization and hysterectomy as treatments of squamous cell lesion of the uterine cervix

En México, el cáncer cervical es el tumor maligno más común y en la actualidad es la primera causa de muerte por neoplasias malignas. Objetivo: Evaluar la conización terapéutica del cuello uterino y la histerectomía extrafascial como método definitivo en el tratamiento de la lesión intraepitelial escamosa (LIE) del cérvix y apreciar, por medio del seguimiento, el éxito del tratamiento. Método: En el Servicio de Ginecología del CECAN en Xalapa, Veracruz, México, se elaboró un estudio retrospectivo de seguimiento mínimo de 4 años a pacientes con LIE, realizándose histerectomía y cono biopsia terapéutico, comparando ambos grupos. Resultados: Las recurrencias se presentaron a los 2 años o antes en todos los casos con un porcentaje del 27 y el 7,3 por ciento para el cono e histerectomía, respectivamente. Conclusiones: La histerectomía extrafascial y la cono-biopsia terapéutica como tratamiento definitivo de la LIE del cuello uterino disminuye su eficacia en la medida que se incrementa el grado de lesión. La evaluación colposcópica preoperatoria sería de gran ayuda para delimitar y descartar lesiones similares en la vagina y vulva. La cono-biopsia es un método útil como tratamiento en la LIE de bajo grado. Es necesario un seguimiento colposcópico y/o citológico anual durante los 5 años posteriores al tratamiento elegido (AU)

[Recurrence of high-grade squamous intraepithelial lesions following hysterectomy]. / Recurrencia de la lesión intraepitelial escamosa de alto grado posterior a histerectomía.

UNLABELLED: The abdominal histerectomy has been used during several years as a definitive treatment for the high grade squamous intraepithelial lesion of the cervix, because it is associated with a high index cure, with 1% to 15% of relapses as neoplastic lesions in the vaginal stump or isolated lesions. The object of this study is to evaluate the extrafascial abdominal histerectomy as an effective and definitive therapeutitic method for the high grade squamous intraepithelial lesion, with an annual colpocythologic follow up. MATERIAL AND METHODS: In the Gynecology Service from the Veracruz State Cancerology Center "Dr. Miguel Dorantes Mesa", of the Secretary of Health in Xalapa Veracruz, a retrospective, study was performed from 41 cases of histerectomy for high grade squamous intraepithelial lesion, with a three year follow up, with the result of 7.3% of recurrence in the vagina stump. CONCLUSIONS: The extrafascial histerectomy as a definitive treatment for the cervical high grade squamous intraepithelial lesion decreases its efficacy while the stage of the lesion increases; the preoperative colposcopic evaluation helpful to determine the illness extension and discard similar lesions on vagina and vulva; five year follow up with annual cytology is mandatory.

[Intestinal obstruction caused by ascaris in pregnancy. Report of a case]. / Obstrucción intestinal por áscaris y embarazo. Presentación de un caso.

A pregnant woman may be infected up to a 90% by intestine parasites, and it all depends on the geographical area associated to the environmental factors allowing this to be spread. The abdominal obstruction related to the pregnancy is rare due to the fact that it only happens in one out of 2,500-6,000 pregnancies. This occlusion, when given by Ascaris lumbricoides, is even more complicated due to the lack of medical literature reference, and thus being unable to make any comparisons. A 45-year old pregnant woman, with several births and multi-pregnancies presenting an acute abdomen by intestinal obstruction through out this helmint. She was pacticed an exploratory laparotomy with the evacuation of several ascaris throughout and enterostomy, and then during the 37th week, she gave birth by means of an eutocic labor work to a healthy female product weighting 2.825 kgs. The anatomopathology study of the placenta shows no alterations. The nosology of the intestinal obstruction by ascariasis during the pregnancy, and out of it, are very similar and could only be affected by late diagnosis of the pregnant woman due to anatomical and physiological changes, increasing the mother's and the fetus morbi-mortality. In Mexico, there are endemic areas where it would be convenient to identify the characteristical eggs in the mother's stool due to the fact that if an advanced pathology is not put in place, it does produce states of maternal malnutrition, anaemia, abdominal pain and low weigh product at the moments of its birth.

[Gynecologic surgery in geriatric patients]. / Cirugía ginecológica en la paciente geriátrica.

UNLABELLED: To establish a precise definition for the geriatric patient, results difficult, since the age limits change constantly and arbitrary way, but given that women are living longer, supposedly the rate of gynecologic surgery is increasing. OBJECTIVE: To inform the experience obteined in our service, from geriatric patients, with surgical intervention, and compare the results with published articles from other national gynecology services. MATERIALS AND METHODS: In the gynecology service of Specialties Hospital "Dr. Miguel Dorantes Mesa" from the S.S., in Xalapa Veracruz, México, a retrospective study was performed, from 76 cases of patients with gynecologic surgery. The research variables were: 60 years old or older, personal pathologic data, gynecologic and obstetrics, occupation, preoperative diagnosis, type of intervention, anatomopathologic diagnosis, anesthesia employed, complications during of after surgery, days in the hospital, hemoglobin and hematocrit. RESULTS: Most of the patients were 65 to 70 years old, 100% housewives, pelvic statics alterations were present in most cases (53.9%), followed by pre-malignant and malignant diseases of the cervix, the abdominal hysterectomy was indicated in 29 cases, 65.7% had personal pathologic data, the anatomopathologic study confirmed 85% of the cases, days-hospital average was 5.8. CONCLUSION: Survivorship does not depend by type of surgery or age, if not to concomitant illness.

[Abdominal hysterectomy at the Hospital de Especialidades Dr. Miguel Dorantes Mesa, S.S. A report on 140 cases]. / La histerectomía abdominal en el Hospital de Especialidades Dr. Miguel Dorantes Mesa, S.S. Informe de 140 casos.

Results from a study involving 140 hysterectomies performed at the "Miguel Dorantes Mesa" Hospital S.S. of Xalapa, Veracruz, between 1990 and 1992, are presented. The variables considered in the study were age, gyneco-obstetric history, pre-operatory indication, associated surgery, anatomopathology diagnosis and its correlation with the pre-operatory diagnosis, operatory technique, associated surgery, size of the uterus, type of endometrium of the quirurgic piece and complications in the immediate and late transoperatory. The results obtained here were also compared with some available from similar studies. The results showed that the main indication was due to pre-malign lesions, followed by benign neoplasias and only 4% due malign processes. The most frequent type of surgery was found to be the extrafascial hysterectomy with the salpingo-oophorectomy as associated surgery. The confirmation of the diagnosis by the anatomopathologic study was 76.1%. The most common type of complications encountered were two bladder lesions, and one of ureter; which were repaired during the transoperatory; two vesicovaginal and one ureterovaginal fistula. There was no mortality.