Condiloma acuminado: eficacia terapéutica comparativa entre el 5-fluorouracilo tópico y la criocirugía / No disponible

ANTECEDENTES. En el condiloma acuminado se han estado utilizando numerosas modalidades terapéuticas; sin embargo, existen pocos estudios que comparen la efectividad entre estas. PACIENTES Y MÉTODO. Se realizó un estudio prospectivo, abierto, para comparar la eficacia terapéutica entre el 5-fluorouracilo en crema al 5% y la criocirugía en el tratamiento tópico del condiloma acuminado. Se incluyeron al azar 40pacientes adultos con este diagnóstico: los primeros 20 pacientes que acudieron a la consulta del consultorio médico de familia 9 del policlínico Managua y los primeros 20 pacientes que acudieron al policlínico docente Joaquín Albarrán, en el período comprendido entre febrero y abril de2006. Se formaron por tanto dos grupos de 20 pacientes cada uno, aplicándose un esquema terapéutico diferente en cada caso, recibiendo los pacientes del policlínico Managua (grupo I) dos aplicaciones semanales de 5-fluorouracilo en crema al 5% y los pacientes del policlínico Joaquín Albarrán (grupo II) una aplicación quincenal de criocirugía. La duración de ambos tratamientos fue la misma (6 semanas en cada grupo).La eficacia terapéutica fue evaluada dos semanas después de culminar el tratamiento, comparando el estado inicial y final de las lesiones. A los pacientes con respuesta total al medicamento se les realizó un seguimiento trimestral durante un año para detectar posibles recidivas. RESULTADO. El análisis pareado inicio-final demostró una respuesta significativa al tratamiento en ambos grupos. Hubo diferencias estadísticamente significativas entre los grupos estudiados. Las tasas de recidivas fueron elevadas en ambos grupos. Los principales eventos adversos observados en ambos grupos fueron: ardor, dolor e inflamación; de intensidad leve y de desaparición espontánea. COMENTARIO. Se demostró que la criocirugía es más eficaz que el 5-fluorouracilo en crema al 5% en el tratamiento tópico del condiloma acuminado (AU)

BACKGROUND. Many different therapies have been used for condyloma acuminata, however, few studies comparing their effectivity have been made. PATIENTS AND METHODS. A prospective, open-label study was conducted to compare therapeutical efficacy between topical 5-fluorouracil (5% cream) and cryosurgery in the topical treatment of condyloma acuminata. Forty adult patients with this diagnosis were randomly chosen, these being the first 20 patients who came to the family doctor’s office 9 in the Managua polyclinic and the first 20 patients who came to the Joaquín Albarrán teaching polyclinic in the period from February to April 2006. Two groups of 20 patients each were formed, applying a different therapeutical scheme in each case. Thus, the patients from the Managua polyclinic (group I) received a twice a week application of topical 5-fluorouracil and those from the Joaquín Albarrán polyclinic (group II) received a fortnightly application of cryosurgery. Both treatments had the same duration (6 weeks in each group). Therapeutical efficacy was assessed two weeks after completing the treatment, comparing the initial and final state of lesions. The patients who responded totally to the medicine were followed-up quarterly for one year in order to detect possible relapses. RESULTS. The start-end comparative analysis showed an outstanding response to the treatment in both groups. There were statistically significant differences between the groups studied. Relapse rates were high in both groups. The majored verse events observed in both group were burning sensation, pain and swelling having mild intensity and spontaneous disappearance. COMMENT. It has been demonstrated that cryosurgery is more effective than topical 5-fluorouracil in the topical treatment of the condyloma acuminate (AU)

[The familial incidence of accessory atrioventricular pathways (the pre-excitation syndrome)]. / Frecuencia familiar de vías accesorias atrioventriculares (síndrome de preexcitación).

Cases of familial preexcitation syndrome represent a specific subgroup of patients that may result from diverse mechanisms: failure in development and genetic predisposition are the main mechanism involved. We determined the prevalence of this syndrome in first degree relatives of patients with proved accessory pathways by electrophysiologic study and compared such prevalence with the general population (0.15%). In five out of 469 patients (1.06%) we found an accessory pathway in one or more member of their family. Only 6 out of 3752 had preexcitation (0.15%); this prevalence was similar to the general population (P = NS). The identification of family members with this syndrome may be incomplete because we only chose for the study symptomatic patients. We did not observed multiple pathways and in one case we found atrial septal defect. Our data demonstrated familial preexcitation in five families suggesting hereditary predisposition.

[Variations in the postoperative length of stay according to patient characteristics in a general surgery service]. / Variaciones del tiempo de estancia postoperatoria según las características de los pacientes en un servicio de cirugía general.

With the purpose of identifying factors that explain variations in length of postoperative stay in a general surgery unit, information from 666 clinical records of discharged alive patients was collected. Factors related to the surgical procedure, the severity of the disease and the medical team together with sociodemographic characteristics of the patients were analyzed. Statistical analysis was based on analysis of variance and multiple linear regression. Variables with statistically significant regression coefficients (p < 0.001) were in this order: severity of complications, type of intervention, need for reintervention and severity of diagnosis. Sixty-seven percent of length of stay variation was explained by the included variables. Results allow to suggest an evaluation procedure which takes into account patient and operation characteristics.