Burning wood in the kitchen increases the risk of cervical neoplasia in HPV-infected women in Honduras.

There is suggestive evidence that the use of wood for cooking increases the risk of invasive cervical cancer. We investigated this association in women with cervical neoplasia in Honduras. Women aged 20-64 years with cervical intraepithelial neoplasia (CIN) grade I (n = 44), CIN II (n = 36) or CIN III (n = 45) were recruited from screening programs in Tegucigalpa City and each was matched by age and clinic to 2 controls (241 total) without cervical abnormalities. The clinics selected women of low socioeconomic status. Cervical scrapes were tested for the presence of human papillomavirus (HPV) DNA using a general primer set directed against the L1 open reading frame, and HPV genotyping was performed. Odds ratios (ORs) were computed through conditional logistic regression; p-values were from tests for linear trend of risk with increasing exposure. HPV DNA was detected in 48% of women with CIN I, 67% with CIN II and 89% with CIN III. The ORs were 1.5, 2.5 and 38.3 respectively. At univariate analysis, age at first intercourse was consistently lower among cases than controls. Risk was reduced by 50% or more in all 3 CIN classes when initiation of sexual activity at age 20 years or older was compared with initiation before age 16 years (p = 0.013 for CIN I). No effect was observed for smoking, oral contraceptives or previous cytologic screening. Effects for number of sexual partners, parity, age at first pregnancy and education were in the expected directions but never persisted after adjustment for HPV. Chronic exposure to wood smoke significantly increased the risk of CIN III (p = 0.022). However, women who said "No" when asked if they ever used wood in the kitchen had a higher risk than those with low or intermediate exposure. This was taken as evidence that the initial screening question had either been misunderstood or that answers were biased. Restricting the analysis to women who reported exposure yielded positive associations in all CIN classes with for CIN III ORs of 2.3 for 25-34 and 9.5 for 35+ years compared with women who had 1-14 years of exposure (p = 0.017). A multivariate analysis of the complete dataset (n = 366) allowed for separate ORs for HPV in each CIN class. Inclusion of age at first intercourse significantly improved this model (p = 0.021). Adding exposure to wood smoke further improved the model only if an interaction between woodsmoke and HPV was allowed for. If, as the data suggest, it was assumed that wood smoke had its effect among HPV-positives only, there was a significant linear dose-response relationship between exposure to woodsmoke and risk of CIN (p = 0.026). This association was independent of other risk factors including education, parity and number of sexual partners. ORs in the final model were 0.37 for age at first intercourse 20 years or higher and 5.69 for more than 35 years of exposure to wood burning in the kitchen. The present study suggests that the use of wood for cooking is a risk factor for cervical neoplasia that deserves further study, given its high prevalence in developing countries.

Broncoscopía anatomía patológica: estudio comparativo Instituto Nacional del Tórax 1989-1990 / Pathological anatomy of bronchoscopy: comparative study on the Instituto Nacional del Tórax 1989-1990

El Broncoscopio de Fibra óptica resulta de invaluable utilidad para la obtención de material para estudio citológico e histológico en el diagnóstico de patologías pulmonares. Se presenta un estudio de 395 pacientes a los cuales se les practicó éste procedimiento en el Instituto Nacional del Torax durante un período de dos años (1989-1990), cuya indicación en la mayoría de los casos fue sospechosa de enfermedad neoplástica o Tuberculosis. El método más utilizado fue el lavado bronquial en 29% de los casos y en 21% fueron realizados tres procedimientos: cepillado, lavado y biopsia; lo que aumenta el grado de positividad diagnóstica. Del total de casos, se confirmó el diagnóstico de malignidad en 68, siendo el método broncoscópico el más efectivo, con un 69% de positividad, comparado con otros como punción pulmonar, biopsia de ganglios, toracotomía exploradora, etc. Esta positividad puede se mejorada si se examinan más muestras de un mismo paciente, y usando otras técnicas como la biopsia por aspiración con aguja transbronquial

Hidatidosis en tejidos blandos: presentación de casow

Se presenta un caso de hidatidosis en un paciente masculino de 58 años, con localización en el brazo derecho. La hidatidosis es una zoonosis que al presentarse en el humano, el pulmón y el hígado son los órganos más frecuentemente afectados. La localización en partes blandas como ocurrió en el caso qeu presentamos es excepcional. Se hacen consideraciones sobre diagnóstico y conducta terapéutica en casos de hidatidosis

Biopsias transoperatorias por congelación: Hospital Escuela 1984-1989 / Transoperation biopsy by freezing: School Hospital 1984-1989

Este es un estudio sobre biopsias transoperatorias (por congelación), basado en 659 biopsias solicitadas al Dpto. de Patología del Hospital Escuela en un período de 6 años 1984-1989). Corresponden 424 al sexo femenino y 235 masculino. Entre las edades de 20 a 69 años con un promedio de 83 biopsias (10.48%) en cada grupo de edad (décadas). Los tejidos que con mayor frecuencia se examinaron en orden de frecuencia son: Sistema Gastro Intestinal 70.5% Sistema Nervioso Central 17.4%, Genital Femenino 14.8% tiroides 12%. El Sistema Nervioso Central Se considera aparte debido al tipo de patología especial de este sistema y excluyéndo, se solicitaron 545 biópsias, diagnosticándose al momento de la congelada 97.8%. Fueron "Positivas por Malignidad" 41.1% y Negativas por Malignidad " 56% con 3.6% de falsos negativos. Se difirieron del 2.2%. En el Sistema Nervioso Central se solicitaron 114 biopsias, realizandose corte congelado a 109 biopsias y se difirieron 5 casos. No hubo falso positivos ni negativos