Prevalencia de las enfermedades alérgicas y su asociación con la lactancia materna y el inicio de la alimentación complementaria en niños de edad escolar de Ciudad Guzmán, México / Prevalence of allergic diseases and their association with breastfeeding and initiation of complementary feeding in school-age children of Ciudad Guzmán, Mexico

Introducción. El efecto que tiene la lactancia materna y la alimentación complementaria sobre la prevalencia de las enfermedades alérgicas ha mostrado resultados inconsistentes. Objetivo. Evaluar el efecto de la lactancia materna y el momento de inicio de la alimentación complementaria en la prevalencia de las enfermedades alérgicas. Población y métodos. Estudio transversal analítico con base poblacional realizado en niños de 6 a 12 años de edad inscriptos en escuelas primarias, seleccionados mediante muestreo polietápico. Se aplicó a sus padres o tutores un cuestionario estructurado para identificar enfermedades alérgicas (asma, rinitis alérgica o dermatitis atópica), antecedente de lactancia materna prolongada y edad de inicio de la alimentación complementaria. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Resultados. Se incluyeron 740 niños. La frecuencia de lactancia e" 6 meses fue 73,4% y de alimentación complementaria con d" 4 meses fue 31,9%. La lactancia materna prolongada no tuvo efecto sobre la prevalencia de las enfermedades alérgicas. Se observó un efecto protector en la frecuencia de la dermatitis atópica cuando el inicio de la alimentación complementaria era tardío, OR ajustado= 0,36; IC95%: 0,1-0,8 (p 0,019). Conclusiones. El efecto protector de la lactancia materna sobre la prevalencia de las enfermedades alérgicas no pudo ser comprobado. La prevalencia de dermatitis atópica es menor con un comienzo tardío de la alimentación complementaria.

Introduction. The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. Objective. To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. Population and Methods. Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. Results. A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). Conclusions. The protective effect ofbreastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.

Prevalence of allergic diseases and their association with breastfeeding and initiation of complementary feeding in school-age children of Ciudad Guzmán, Mexico.

INTRODUCTION: The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. OBJECTIVE: To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. POPULATION AND METHODS: Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. RESULTS: A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). CONCLUSIONS: The protective effect of breastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.

Design and field-scale implementation of an "on site" bioremediation treatment in PAH-polluted soil.

An "on site" bioremediation program was designed and implemented in soil polluted with polycyclic aromatic hydrocarbons (PAHs), especially naphthalene. We began by characterizing the soil's physical and chemical properties. A microbiological screening corroborated the presence of microorganisms capable of metabolizing PAHs. We then analyzed the viability of bioremediation by developing laboratory microcosms and pilot scale studies, to optimize the costs and time associated with remediation. The treatment assays were based on different types of biostimulants, such as a slow or fast-release fertilizer, combined with commercial surfactants. Once the feasibility of the biostimulation was confirmed, a real-scale bioremediation program was undertaken in 900 m(3) of contaminated soil. The three-step design reduced PAH contamination by 94.4% at the end of treatment (161 days). The decrease in pollutants was concomitant with the selection of autochthonous bacteria capable of degrading PAHs, with Bacillus and Pseudomonas the most abundant genera.

Detection and enumeration of E. coli O157:H7 in water samples by culture and molecular methods.

The performances of three chromogenic agars were evaluated for the recovery of Escherichia coli O157:H7 from spiked dechlorinated tap, ground and surface water, and treated drinking water samples. The chromogenic agars: ChromAgar O157 (CHROM), Rainbow Agar O157 (RB) and HiCrome EC O157 (HC) were compared to cefixime-tellurite Sorbitol MacConkey (CT-SMAC), commonly used for the isolation of E. coli O157:H7. Confirmation of suspect E. coli O157:H7 colonies were performed by colony real-time PCR (C-RTi-PCR) based on the presence of Shiga-toxin genes (stx1 and stx2). Recovery of inoculated E. coli O157:H7 from dechlorinated tap water indicated that RB and CHROM agars demonstrated improved recovery when compared to HC or CT-SMAC. There was a significant drop in recovery on all agars tested after 120h (day 5). Twenty dechlorinated tap and/or treated drinking water samples were inoculated with a pure culture of E. coli O157:H7 (ATCC 43894), and a mixed culture of E. coli O157:H7 (ATCC 43894), E. coli strain K-12, and Enterococcus faecalis (ATCC 063589). After a 48-hour holding time, the recovery using CHROM (99%) and HC (12%) from samples contaminated with the pure culture were found to be significantly different (p<0.05). Recovery results using CHROM (39%) and CT-SMAC (32%) from samples contaminated with the mixed culture after a 48-hour holding time were not significantly different (p>0.05). Analysis by C-RTi-PCR of forty five environmental water samples (surface, sewage, and final effluents) which were negative for E. coli O157:H7 showed an incidence of false suspect positive colonies of 38% (CHROM), 53% (RB), 58% (HC), and 91% (CT-SMAC). Further analysis of eight of the environmental samples inoculated with E. coli (ATCC 43894) showed 100% recovery when utilizing CHROM, 50% when using RB and 40% when using HC. In addition, the C-RTi-PCR positive confirmation rate was 100% for CHROM and HC and 65% for RB. CHROM demonstrated improved recovery of E. coli O157:H7 over RB, HC, and CT-SMAC in terms of sensitivity and specificity.

[Flat, depressed and polypoid colorectal lesions: a comparative study using a index of histological advance]. / Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. OBJECTIVES: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences. .

Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico / Flat lesions, and polypoid colorectal depressed: a comparative study using a histologic progress index

ANTECEDENTES: Se ha descrito que las lesiones planas y deprimidas colorrectales, llamadas también no polipoides (LNP) tienen una histología más avanzada que las polipoides o protruidas (LP). OBJETIVOS: Comparar el grado de avance histológico de las LNP con el de las LP, a nivel del colon y recto. Validar el uso de un Índice de Avance Histológico (IAH) para objetivar estas diferencias. METODOLOGÍA: Estudio observacional, prospectivo, realizado en adultos programados a colonoscopía en un Centro Endoscópico privado de Lima- Perú. Dos grupos: 417 pacientes con LNP (planas, deprimidas y de crecimiento lateral o LST) y 405 pacientes con solo LP. RESULTADOS: 417/ 8,248 pacientes (5%) tuvieron LNP; 368 (4.5%) planas, 27(0.32%) deprimidas y 22(0.26%) LST. Según nuestro IAH, las lesiones planas y polipoides mostraron similar avance histológico. Las LST tuvieron una histología más avanzada y las deprimidas alcanzaron los valores más altos. Las lesiones planas tuvieron mayor tendencia que las polipoides a situarse en colon derecho (31% vs 22% p< 0.01), a presentar histología aserrada (9% vs 2% p< 0.01) y displasia de alto grado (5% vs 3% NS), pero menor tendencia al cáncer (0.2% vs 1% NS). Comparadas con las polipoides, las deprimidas tuvieron similar displasia de alto grado (3.7% /NS) pero una alta proporción de cáncer (18 % p < 0.01), mientras que las LST se localizaron sobre todo en colon derecho y recto, con componente velloso en 23% (p< 0.01) y displasia de alto grado en 32% (p< 0.01), pero no cáncer. CONCLUSIONES: Las lesiones planas mostraron un grado de avance histológico similar a las polipoides, pero las de crecimiento lateral si tuvieron una histología más avanzada y las deprimidas desarrollaron cáncer en una elevada proporción. El Índice de Avance Histológico fue una herramienta útil para comparar los grupos y resaltar sus diferencias.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. Objectives: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences.

Evaluation of novel agars for the enumeration of Campylobacter spp. in poultry retail samples.

The purpose of this study was to examine the performance of novel agars for the identification and enumeration of Campylobacter species. The analytical sensitivity and specificity of Campylobacter Selective agar (CASA), Brilliance CampyCount agar (BCCA) and CampyFoodIDagar (CFA) for 84 Campylobacter spp. isolates and 50 non-Campylobacter spp. isolates from 37 distinct genera were of 100% sensitivity, with a 98% specificity for BCCA and CFA, and a 100% specificity for CASA. The application of these selective agars for Campylobacter spp. enumeration in comparison to the conventional agars, modified charcoal cefoperazonedeoxycholate agar (mCCDA) and Campy-Cefex (CCA) was examined using Campylobacter jejuni and Campylobacter coli inoculated samples. From C. jejuni inoculated samples, recovery on BCCA was significantly greater than other media (p<0.05). Recovery on CASA was not significantly different from mCCDA and CCA (p>0.05). With C. coli inoculated samples, recovery was significantly greater on BCCA and CASA than with other media (p<0.05). The recovery of both C. jejuni and C. coli from inoculated samples with CFA was significantly less than with other media (P<0.05). CASA was able to effectively inhibit and differentiate Campylobacter spp. from background microflora while false positive organisms occurred with BCCA and CFA. An examination of 483 randomly selected suspect Campylobacter colonies from naturally contaminated samples demonstrated a colony confirmation rate for CCA, CFA, BCCA, mCCDA, and CASA, of 84%, 87%, 88%, 90%, and 100%, respectively. The media evaluated present an alternative to conventional selective agars for the identification and enumeration of thermotolerant Campylobacter spp. from samples of poultry origin through the farm to fork continuum.

Enfermedad de Chagas en Perú: transmisión congénita / Chagas disease in Peru: congenital transmission

American Trypanosomosis is an important parasitic infection in Peru. Human cases, reservoirs and vectors have been showed in two known geographic areas in the endemic zones: southwestern and northern and northeastern regions of the country; however vectors belonging to the three genera of triatominae: Triatoma, Panstrongylus and Rhodnius have been collected in almost all the territory. The serological surveys in blood banks in the southwestern region is 2-6% and human cases found out of the endemic areas show the possibility of congenital cases. The study of the prevalence is starting. This preliminary study performed on 3000 pregnant of Arequipa shows serological positives in 22 (0.7%) and only a newborn positive at IgM. This result indicates a probable low rate of congenital transmission and necessary to perform more studies.

[Human blastocystosis: prospective study symptomatology and associated epidemiological factors]. / Blastocystosis humana: estudio prospectivo, sintomatologia y factores epidemiologicos asociados.

An attempt has been made to contribute to the understanding of the symptoms and factors associated with the Blastocystis Hominis infection, as seen in persons seeking outside consultation from the Dermatological and Transmissible Diseases Department (DTDD) at the C.H.N.H. This is a case-control study carried out in people between the ages of 5 and 80 in a period from January to March 1999. The cases tested positive in parasitological tests for Blastocystis Hominis and were absent of other enteropathogens. The controls tested negative in parasitological tests for Blastocystis Hominis and were absent of other enteropatoghens. A clinical chart was used to register details of symptomatology and factors associated with the Blastocystis Hominis infection. 74 cases and 70 controls were studied, matched by sex and age. A statistical correlation was obtained (p<0.05) among symptomatic persons and presence of Blastocystis Hominis (91,9%). The symptomatology associated with the Blastocystis Hominis infection by order of statistical significance (p<0.05) was: Abdominal pain (OR=3) 1.47

HPV types and cofactors causing cervical cancer in Peru.

We conducted a hospital-based case-control study in Peru of 198 women with histologically confirmed cervical cancer (173 squamous cell carcinomas and 25 cases of adenocarcinoma/adenosquamous carcinoma) and 196 control women. Information on risk factors was obtained by personal interview. Using PCR-based assays on exfoliated cervical cells and biopsy specimens, HPV DNA was detected in 95.3% of women with squamous cell carcinoma and in 92.0% of women with adenocarcinoma/adenosquamous carcinoma compared with 17.7% in control women. The age-adjusted odds ratio was 116.0 (95% Cl = 48.6-276.0) for squamous cell carcinoma and 51.4 (95% Cl = 11.4-232.0) for adenocarcinoma/adenosquamous carcinoma. The commonest types in women with cervical cancer were HPV 16, 18, 31, 52 and 35. The association with the various HPV types was equally strong for the two most common types (HPV 16 and 18) as for the other less common types. In addition to HPV, long-term use of oral contraceptives and smoking were associated with an increased risk. HPV is the main cause of both squamous cell carcinoma and adenocarcinoma in Peruvian women.

A comparison of intratracheal pulmonary ventilation to conventional ventilation in a surfactant deficient animal model.

OBJECTIVE: To compare intratracheal pulmonary ventilation (ITPV) with conventional ventilation in a rabbit model of surfactant deficiency. DESIGN: A prospective randomized animal study. SETTING: The Children's National Medical Center Research Animal Facility in Washington, DC. SUBJECTS: Adult male New Zealand white rabbits (n = 20), weighing 1.4-4.2 kg. INTERVENTIONS: After anesthesia and catheter placement, rabbits were tracheotomized, paralyzed, and placed on the conventional ventilator. We determined pulmonary functions at baseline. We washed surfactant out of the lungs by using serial bronchoalveolar lavages. Pulmonary function studies were determined after completion of the bronchoalveolar lavages and were used as an indication of severity of lung injury. Animals were randomized into two groups: We placed ten animals on ITPV, using the ITPV reverse thruster catheter designed by Kolobow and a prototype ITPV ventilator designed at Children's National Medical Center; we placed ten animals on conventional ventilation using the Sechrist iv-100 ventilator. Arterial blood gases were drawn every 15 mins, and the ventilator settings were adjusted to the minimal level that would maintain arterial blood gases in the following ranges: pH 7.35-7.45, PaCO2 30-40 torr (3.995.33 kPa), PaO2 50-70 torr (6.66-9.33 kPa). Animals were ventilated with the randomized ventilation techniques for 4 hrs. MEASUREMENTS AND MAIN RESULTS: Peak inspiratory pressure, mean airway pressure, and positive end-expiratory pressure were measured at the distal end of the endotracheal tube. We recorded these variables plus respiratory rate at baseline and every 30 mins for a total of 4 hrs of ventilation. Lung compliance did not differ between groups at the postlavage study period (ITPV, 0.56+/-0.13 mL/cm H2O/kg; conventional 0.49+/-0.15 mL/cm H2O/kg). At the end of the 4 hr study period, peak inspiratory pressure (ITPV, 26.2+/-4.6 cm H2O; conventional, 32.4+/-5.04 cm H2O, p = .007) and positive end-expiratory pressure (ITPV, 3.9+/-1.96 cm H2O; conventional, 6.3+/-1.42 cm H2O, p = .005) were lower in the ITPV ventilation group. Peak inspiratory pressure was significantly lower in the ITPV group by 2 hrs into the study. CONCLUSION: In this model of surfactant deficiency lung injury, ventilation and oxygenation were achieved at significantly lower ventilator settings using ITPV compared with conventional ventilation. Long-term studies are needed to determine whether this reduction in ventilation is maintained, and if so, if lung injury is reduced.

Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device.

BACKGROUND AND OBJECTIVES: Complications related to cerebrospinal fluid (CSF) leak and low CSF pressure can occur following placement of an intrathecal drug delivery device. METHODS: A 58-year-old man with chronic, intractable lower back pain underwent implantation of an intrathecal drug delivery device. On the fourth postoperative day, he developed a postural headache and diplopia with findings compatible with left sixth cranial nerve palsy. The headache subsequently became constant and nonpostural. Cranial magnetic resonance imaging was obtained that showed the presence of a posterior subdural intracranial hematoma. Conservative treatment for postdural puncture headache did not improve the symptomatology. Therefore, an epidural blood patch was performed that produced rapid improvement and eventual resolution of symptoms. CONCLUSIONS: Intrathecal catheter implantation can result in CSF loss that might not resolve promptly with conservative therapy. In this case, epidural blood patch proved to be a safe and effective form of treatment.

Amoeba angeitic lesions of the central nervous system in Balamuthia mandrilaris amoebiasis.

Balamuthia mandrilaris amoebiasis is a fatal disease. It primarily affects the nasal pyramid or the skin, producing granulomatous amoebic lesions. The amoeba spread from the primary nasal lesion to the meninges where they infiltrate vessels. Thrombotic amoebic angitis produce infarcts of the central nervous system substance which then become infiltrated by amoeba. The primary cutaneous lesion can be present for weeks or even months. However, the appearance of neurological disease predicts a poor prognosis, in which death usually occurs within a few days or weeks.

Reduced airway resistance and work of breathing during mechanical ventilation with an ultra-thin, two-stage polyurethane endotracheal tube (the Kolobow tube).

OBJECTIVES: To compare dynamic pulmonary function studies using the ultrathin walled Kolobow endotracheal tube, with conventional endotracheal tubes of similar external diameter on rabbits during mechanical ventilation. To test the hypothesis that the increased internal diameter of the Kolobow tube will result in decreased airway resistance and work of breathing. DESIGN: Controlled animal study. SETTING: Institutional animal research facility. SUBJECTS: Adult female Dutch Belted rabbits (n = 6), weighing 1.4 to 1.6 kg. INTERVENTIONS: The animals were initially intubated with a conventional endotracheal tube (2.5-mm internal diameter; 3.6-mm outer diameter); they were paralyzed and placed on a mechanical ventilator. Ventilatory settings were adjusted to obtain standard arterial blood gases: pH of 7.35 to 7.45; PaCO2 of 35 to 40 torr (4.7 to 5.3 kPa), and PaO2 of 90 to 100 torr (12.0 to 13.3 kPa). After the stabilization period, pulmonary function tests (PFTs) were measured (period 1), the conventional endotracheal tube was replaced with a Kolobow tube, and PFTs were measured again and recorded (period 2). While continuously monitoring tidal volume, the peak inspiratory pressure was decreased to match the tidal volume measured during ventilation with the conventional endotracheal tube. Once the desired tidal volume was reached, PFTs were recorded (period 3). Flows were unchanged during the experiment and the length of the endotracheal tubes was the same for both the conventional and the Kolobow tube. MEASUREMENTS AND MAIN RESULTS: Mean values of the airway resistance and work of breathing from periods 1 and 3 were compared using the Student's t-test. There was a 59% decrease in total airway resistance (p = .001) and 45% decrease in the work of breathing (p = .0006). CONCLUSIONS: The use of the ultrathin walled Kolobow endotracheal tube resulted in significant decreases in airway resistance and work of breathing, which has the potential for improving the ventilatory mechanics in very small premature newborns.

Tumor de células de la granulosa de ovario / Tumor of cells of the granular one of ovary

El tumor de células de la granulosa de ovario es una neoplasia relativamente rara, caracterizada por tener crecimiento lento y recurrente tardía, además, de estar asociada a producción de hormonas. Se realizó un estudio retrospectivo de 77 casos presentados en el Instituto de Enfermedades Neoplásicas (INEN) entre enero de 1960 y diciembre de 1995. La edad promedio fue 47.7 años, y los síntomas más frecuente fueran dolor abdominal y sangrado postmenopáusico. El 70 por ciento de los casos fueron estadío I y la sobrevida global a 10 años fue 70 por ciento presentándose las recurrencias luego de 40.7 meses en promedio. El estadío y el índice mitótico se consideran principales factores pronósticos.

One-session management of cervical intraepithelial neoplasia: a solution for developing countries.

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

One-Session Management of Cervical Intraepithelial Neoplasia: A Solution for Developing Countries. A Prospective, Randomized Trial of LEEP versus Laser Excisional Conization

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

[Asymptomatic rectosigmoid perforation and peranal extrusion of a catheter of ventriculoperitoneal derivation]. / Perforación rectosigmoide asintomática y extrusión peranal de catéter de derivación ventriculoperitoneal.

A case of asymptomatic rectosigmoid perforation and peranal extrusion of the distal portion of the ventricle-peritoneal shunt catheter in an infant with congenital hydrocephalus is reported. It is studied the mechanism of the spontaneous reduction of the missing tube and the form to approach this rare complication.