Resultados de la atención a pacientes con lesión intraepitelial escamosa cervicouterina de bajo grado / Results of the healthcare of women with low-grade squamous intraepithelial lesions

Introducción A las lesiones precursoras causadas por el virus del papiloma humano usualmente les lleva de 10 a 20 años desarrollar un cáncer invasivo. La mayoría de los cánceres cervicales pueden prevenirse con la detección precoz y el tratamiento de las lesiones precancerosas. Objetivo Describir los resultados de la atención a estas pacientes. Método Se realizó un estudio prospectivo, longitudinal y descriptivo en 210 mujeres con diagnóstico citológico de lesión intraepitelial escamosa cervicouterina de bajo grado en el Hospital Ginecobstétrico Docente «Mariana Grajales» de Santa Clara, Villa Clara, en el año 2009.ResultadosLa mayoría eran mayores de 25 años de edad, el 84,76% iniciaron su vida sexual antes de los 20 años, tenían más de 20 años de vida sexual y declararon 2 o 3 parejas sexuales. Solamente el 17,5% usaban métodos anticonceptivos que ofrecían protección contra una infección de transmisión sexual y el 70,3% habían parido una o 2 veces. El mayor número de los hallazgos colposcópicos fueron normales (49,5%) y se encontraron imágenes anormales en 37,6%. Se decidió realizar biopsia del cuello uterino a 74 de las pacientes (35,4%) y se juzgó oportuno realizar seguimiento citocolposcópico durante 2 años a 184 mujeres (87,6%). La mayoría de las citologías evolutivas a los 6 meses realizadas en las pacientes con seguimiento citocolposcópico fueron normales. Conclusiones Con una correcta evaluación citocolposcópica unida al análisis adecuado de las características epidemiológicas de las mujeres con lesión inicial citológica de LIEBG, resulta en una adecuada opción de seguimiento y control para estas mujeres (AU)

Introduction Precursor lesions caused by the human papilloma virus (HPV) usually take 10 to 20 years to progress to invasive cancer. Most cervical cancers can be prevented by the early detection and treatment of precancerous lesions. Objective To describe the results of the healthcare of these patients. Method We carried out a prospective, longitudinal and descriptive study of 210 women with a cytological diagnosis of low-grade squamous intraepithelial lesions (LSIL) in the Mariana Grajales de Santa Clara teaching hospital in Villa Clara (Spain) in 2009.ResultsMost of the women were older than 25 years of age, 84.76% commenced sexual activity before the age of 20, had more than 20 years of sexual activity and reported having had two or three sexual partners. Only 17.5% used birth control methods that provided protection against sexually-transmitted diseases and 70.3% had one or two children. The results of colposcopy were normal in 49.5%. Abnormal images were found in 37.6%. Biopsy of the uterine neck was performed in 74 patients (35.4%) and a 2-year cytological-colposcopic follow-up was deemed opportune in 184 women (87.6%). The results of most of the follow-up cytologies carried out at 6 months in patients with cytological-colposcopic follow-up were normal. Conclusions Correct cytological-colposcopic evaluation, together with appropriate analysis of the epidemic characteristics of women with LSIL, constitutes appropriate follow-up in these women (AU)

Endometriosis cervical. Presentación de un caso / Cervical Endometriosis. A case report

Se presenta el caso de una endometriosis cervical en una paciente de 33 años de edad, cuyo diagnóstico se realiza mediante la colposcopia y el estudio anatomopatológico de la biopsia de cuello dirigida, atendida en la consulta de patologia del tracto genital inferior del Hospital Materno Provincial Mariana Grajales de Santa Clara, Villa Clara. La paciente fue tributaria de conización de cuello por asa diatérmica donde se arribó a esta conclusión diagnóstica con una evolución satisfactoria (AU)

We report a case of cervical endometriosis in a 33-year-old patient who was diagnosed by means of colposcopy and histopathological study of directed neck biopsy and who was attended in the lower genital tract clinic of the Mariana Grajales de Santa Clara Provincial Maternity Hospital, in Villa Clara. The patient underwent diathermy loop conization of the uterine neck, which gave the diagnosis of cervical endometriosis. Outcome was satisfactory (AU)

Evolución, complicaciones y repercusión económica del embarazo ectópico según algoritmo para su asistencia / Type of onset, complications and economic impact of ectopic pregnancy according to its management

Se realizó un estudio longitudinal, descriptivo, prospectivo en el Servicio de Ginecología del Hospital Universitario Ginecoobstétrico Mariana Grajales, en Santa Clara, Villa Clara, en el período de enero de 2003 a diciembre de 2006, con el objetivo de caracterizar los factores asociados con la evolución y complicaciones del embarazo ectópico, en relación con el itinerario seguido así como la repercusión económica de esta entidad con relación a su manejo. Se incluyeron un total de 583 pacientes con diagnóstico de embarazo ectópico a las que se les aplicó un instrumento en forma de cuestionario aplicado, que incluyó variables directas e indirectas para el análisis y procesamiento estadístico. En los resultados se evidencia un incremento del embarazo ectópico en los últimos años respecto al número de nacimientos (1/48,7, 1/28,7, 1/34,0 y 1/33,3, respectivamente). Los principales factores de riesgo se corresponden con la incidencia en estas pacientes de enfermedad inflamatoria pélvica, 62,7%, seguido del uso de DIU, 40,8%, el tabaquismo 34,4%, y los antecedentes de instrumentación tubárica, 5,3%. La forma de evolución que predominó fue la aguda en 310 pacientes, 53,2%. El 77,6% de las pacientes se diagnosticó presuntamente en la atención primaria de salud y se remitieron hacia la atención hospitalaria donde se confirmó el diagnóstico. El seguimiento de un itinerario correcto repercute en la aparición de un menor número de complicaciones en las pacientes. El coste económico en el seguimiento médico-terapéutico de estas pacientes se ve afectado por la dependencia de la ruta correcta o incorrecta en relación con el itinerario seguido. Las pacientes que acuden con embarazo ectópico complicado requieren la utilización de mayor número de medicamentos y el uso de transfusiones de sangre que incrementan el coste total a 68.959,55 $ MN (AU)

To characterize the factors associated with the type of onset, complications, and economic impact of ectopic pregnancy according to the management of this entity, we performed a longitudinal, descriptive, prospective study in the Gynecology Service of the Mariana Grajales University Gynecology and Obstetrics Hospital in Santa Clara, Villa Clara (Cuba) between January 2003 and December 2006. A total of 583 patients with a diagnosis of ectopic pregnancy were included. Direct and indirect variables were gathered for statistical analysis. The results showed an increase in the number of ectopic pregnancies in relation to the number of births (1/48.7, 1/28.7, 1/34.0 and 1/33.3 respectively). The main risk factors were pelvic inflammatory disease in 62.7%, followed by the use of an intrauterine device in 40.8%, smoking in 34.4%, and tubal procedures in 5.3%. Onset was acute in 310 women (53.2%), while 77.6% received a presumptive diagnosis in primary care and were referred to hospital where the diagnosis was confirmed. Correct management of ectopic pregnancy reduces the number of complications in these patients and modifies the cost of follow-up. Medication and blood transfusion requirements were higher in women with complicated ectopic pregnancy, increasing the total cost to $68, 959.55 MN (AU)

[Massive hematuria from artery-ureteral fistula]. / Hematuria masiva por fístula arterio-ureteral.

We present a case of massive hematuria from artery-ureteral fistula due to urologic complication of the protesic vascular surgery. These kinds of fistula are a rare case of massive macroscopic hematuria and the commonest clinical presentation is the intermittent hematuria. The only therapeutic possibility is surgical.

[Endobronchial and laryngeal metastasis. An unusual form of dissemination of the hypernephroma]. / Metástasis endobronquiales y laríngeas. Una forma poco habitual de diseminación del hipernefroma.

OBJECTIVE: To describe uncommon forms of dissemination of hypernephroma. METHODS: A case of hypernephroma that metastasized to the laryngeal vallecula and bronchi is presented. Our findings were compared with those reported in the literature. The diagnostic, radiological, clinical aspects and route of dissemination of some atypical sites of metastasis are discussed. RESULTS/CONCLUSIONS: It is important to be familiar with these atypical sites of metastasis since these lesions may appear at the same time or before the primary tumor is detected. A high index of suspicion will make a major impact on treatment and prognosis. The radiological findings are undoubtedly of enormous value, although histological confirmation is necessary in order to make the correct diagnosis.

[DNA ploidy and cell cycle phase analysis with flow cytometry in bladder wash. Preliminary experience]. / Análisis de ploidía de ADN y fases del ciclo celular por citometría de flujo en el lavado vesical. Experiencia preliminar.

OBJECTIVE: To analyze the prognostic significance in bladder carcinoma of DNA ploidy and cell phase fractions measured by bladder wash flow cytometry. METHODS: Samples were obtained from 25 patients by bladder irrigation; 16 before surgery and 9 during follow-up cystoscopic examination. Cells were stained with propidium iodide and analyzed with the FacScan flow cytometer and Cellfit 2.01 (Becton-Dickinson). RESULTS: The number of cells obtained was sufficient for flow cytometric analysis in all cases. In 13 tumor samples (8 superficial and 5 invasive tumors), aneuploidy cells were detected in 3 cases that had a worse outcome; the only superficial tumor in which aneuploidy was detected presented a recurrent bladder carcinoma 15 months later. Of the 5 patients with invasive tumors, two patients with aneuploidy died within 6 months from tumor metastases. Of the patients without macroscopic tumor, only one showed an increase in the percentage of the S phase fraction (19.5% of cells in S phase). A recurrent bladder carcinoma was detected in this patient 6 months after the analysis. In patients with macroscopic tumor, analysis of the S phase fraction was not relevant for prognosis. CONCLUSIONS: Analysis of DNA ploidy and cell phase fractions by flow cytometry of bladder washings can increase the prognostic information in bladder carcinoma. Aneuploidy was associated with a worse prognosis and an increase in the S phase fraction predicted a recurrent bladder carcinoma months before it manifested clinically.

[Retroperitoneal ganglioneuroma]. / Ganglioneuroma retroperitoneal.

Presentation of one case of retroperitoneal ganglioneuroma in a 31-year old female. This type of neoformation, with origin at the sympathetic system nodes level, is considered to be the benign homologous of neuroblastoma. Peak incidence age ranges from 3 to 20 years. The retroperineum is one of the most frequent sites, second only to the mediastinum. Diagnosis is normally casual and is considered definite when, following mass removal and completion of the pathoanatomical study, the presence of neuroblasts in the tumour can be ruled out.

[Acute scrotum: unusual presentation of Schönlein-Henoch purpura]. / Escroto agudo: un modo de presentación insólito de la púrpura de Schönlein-Henoch.

Being a systemic vasculitis, Schöenlein-Henoch purpura may affect the scrotum and its content. According to the series studied, this occurs in about 10% patients (2-38%) and sometimes requires a differential diagnosis with the spermatic cord torsion. An isotopic study with 99Tc may avoid a surgical procedure quite often unnecessary. In the case reported here, vasculitis presented as an acute scrotum, which is highly infrequent in the literature and makes a correct presumption diagnosis extraordinary difficult.

[Intraparenchymatous vascular tumors of the testicle: report of a new case of cavernous hemangioma]. / Tumores vasculares intraparenquimatosos de testículo: aportación de un nuevo caso de hemangioma cavernoso.

The occurrence of a vascular tumour at the intraparenchymatous testicular level is a fact little reported in the literature. Searching for such events, 19 cases were found all of which showed benign clinical behaviour. The most commonly seen histological pattern is cavernous haemangioma (11 patients). Mean age at presentation is 19 years old and the most usual pre-operative diagnosis, germinal cell neoplasia. Since there are no specific ultrasound patterns that may allow to differentiate benign from malignant masses, inguinal orchiectomy is the choice treatment in this type of lesions. Furthermore, the case of a 44-year old patient with hypoechogenic solid mass in left testis who consulted for sporadic episodes of long-standing scrotal pain is presented. After radical exeresis of the gonad, the histological analysis showed existence of testicular cavernous haemangioma.