Prognostic value of systemic immune-inflammation index and serological biomarkers for deep neck infections.

BACKGROUND: Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and the systemic immune-inflammation index, have been proposed as prognostic factors diverse pathologies. However, their application for deep neck infections has yet to be clarified. MATERIAL AND METHODS: We performed a retrospective study of 163 adult patients with diagnosis of deep neck infections with the aim to evaluate the association between serological biomarkers with complications and outcomes of patients with DNI. Studied variables included demographic data, complications of DNI, outcomes, complications and death of the included subjects. The evaluated serological biomarkers were hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, glucose, creatinine, albumin, CRP, and ESR. NLR, PLR, and SIII index were estimated. RESULTS: The patients' mean age was 40.6 ± 15.3 years. Complications of DNI were observed in 19.6% (n=32) patients, being the need for tracheostomy due to airway obstruction (11%, n=18) and mediastinitis (8.6%, n= 14) the most common. Evaluated subjects had an increased value of serological biomarkers (SII index 2639.9 ± 2062.9, NLR 11.3 ± 8.5, PLR 184.1 ± 108.5, CRP 12.6 ± 8.9 mg/dL, ESR 20.7 ± 9.1 mm/h). Patients with complications had a significantly higher value of all inflammatory parameters (p < 0.05). A SII index cut-off value of 2975 was selected from a ROC curve analysis. A sensitivity of 93.8%, specificity of 86.3%, a positive predictive value of 62.5%, and a negative predictive value of 98.3% are reported. The SII index was found to have an increased positive predictive value compared to NLR, PLR, and CRP for DNI complications. CONCLUSIONS: Our analysis concluded that the SII index, NLR, and PLR are valuable biomarkers to assess the risk of complications from DNI. SII index showed a high accuracy for prediction of DNI complications with a cut-off value of 2975.

Morphometric variants of the paranasal sinuses in a Mexican population: expected changes according to age and gender.

BACKGROUND: There are developmental variations in the paranasal sinuses. Our objective was to determine their dimensions and volume stratified by age and sex and define the expected growth pattern. MATERIALS AND METHODS: A retrospective, observational study was performed including computed tomography (CT) of patients between 1 and 20 years of age. The volumes of the frontal, sphenoid, and maxillary sinuses were obtained. RESULTS: A total of 210 CT were included with a mean age of 10 ± 6.1 years, 106 (50.5%) were female. Groups were categorised in ranges of 5 years. Spearman correlation coefficients between the right and left sides were 0.843, 0.711, 0.916 for the frontal, sphenoid and maxillary sinuses. Post-hoc for the categorical age groups demonstrated statistically significant differences with values of p < 0.01, except between age groups 11-15 against ≥ 16 years of age (p = 0.8). Gender-related differences were evident with a higher air volume in girls in the 5-10-year-old group, while boys predominated in the rest of the groups. CONCLUSIONS: Computed tomography is ideal for pre-surgical sinus assessment. The maximum volume of paranasal sinuses is reached at the age of 15. There is a clear volumetric difference between age and gender groups. There is a direct relationship between a volume and its contralateral counterpart.

Anatomical configurations of the optic canal in the sphenoid sinus in a Hispanic population: computed tomography based study.

OBJECTIVE: The prevalence of the optic canal anatomical variants across the sphenoid sinus varies widely among different ethnic groups. This study aimed to analyse the anatomical variants of the optic canal and their relationship to sphenoid sinus pneumatisation in a Hispanic population. METHOD: A review of 320 sphenoid sinuses by high-resolution computed tomography was performed. DeLano's classification of the optic canal, presence of dehiscence, septa insertion, sphenoid sinus pneumatisation and presence of Onodi cells were established. RESULTS: Dehiscence of the optic canal was observed in 4.7 per cent (n = 15) of the analysed sinuses. Type 4 and 3 optic canals were significantly more frequent among postsellar sphenoid sinuses than other patterns of sphenoid sinus pneumatisation (p = 0.002 and p = 0.018). A type 4 optic canal has a higher tendency to present inserted septum than other optic canal types (p = 0.014). CONCLUSION: This study described the optic canal variants in a Hispanic population, which complements existing literature addressing other ethnicities.

Role of early extraction of odontogenic focus in deep neck infections.

BACKGROUND: Odontogenic deep neck infections remain a common condition that presents a challenging issue due to the complex involvement of the neck and adjacent structures and its potential life-threatening risk. Periapical infection of the second or third molar with spread to the submandibular and parapharyngeal spaces is the most commonly observed scenario. However, the time of dental extraction of the infection focus remains controversial. The aim of this study is to provide an overview of the epidemiology, clinical and radiological features, and management in patients diagnosed with ODNI and to identify the role of early dental extraction on patient outcomes and recovery. MATERIAL AND METHODS: This retrospective study included patients over 18 years old with a diagnosis of ODNI who were admitted to the University Hospital "Dr Jose Eleuterio Gonzalez" from January 2017 to January 2022. ODNI diagnosis was based on clinical and radiological evidence of the disease supplemented by dental and maxillofacial evaluation for an odontogenic aetiology. RESULTS: A total of 68 patients were included in the study. The patients' mean age was 40.96 ± 14.9. Diabetes mellitus was the most common comorbidity. The submandibular space was the most common deep neck space involved (n=59, 86.8%). Mediastinitis, marginal nerve injury and orocervical fistula were observed in 7.5% of patients, with no fatality in this series. A delay of >3 days for dental extraction of the involved tooth was associated with an increased rate of mediastinitis (n=3, 100%, p= 0.022), number of surgical interventions (1.45 ± 0.61, p= 0.006), ICU stay (n=8, 40%, p= 0.019), and ICU length of stay (0.85 ± 0.8, p= 0.001). CONCLUSIONS: Expedited management with surgical drainage and intravenous antibiotic treatment, along with early extraction of the involved tooth, is mandatory.

A Study of Zn-Ca Nanocomposites and Their Antibacterial Properties.

This study aimed to develop Ca2+ doped ZnO nanoparticles (NPs) and investigate their antibacterial properties against microorganisms of dental interest. Zn-Ca NPs were synthesized by the sol-gel method with different concentrations of Ca2+ (1, 3, and 5 wt. %) and subsequently characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), UV-vis spectroscopy and Fourier transform infrared spectroscopy (FT-IR). The Kirby-Bauer method was used to measure antibacterial effects. NPs showed the wurzite phase of ZnO and bandgap energies (Eg) from 2.99 to 3.04 eV. SEM analysis showed an average particle size of 80 to 160 nm. The treatments that presented the best antibacterial activity were Zn-Ca 3% and Zn-Ca 5%. ZnO NPs represent an alternative to generate and improve materials with antibacterial capacity for dental applications.

[Correlation between clinical and tomographic variables in patients with neurocysticercosis. A study in a cohort of patients in Sierra Norte, Ecuador, between 2019 and 2020]. / Correlación entre variables clínicas y tomográficas en pacientes con neurocisticercosis. Estudio en una cohorte de pacientes de la Sierra Norte ecuatoriana entre 2019 y 2020.

INTRODUCTION: Neurocysticercosis (NCC) is the most frequent parasitic disease in the central nervous system of humans. OBJECTIVE: to establish the correlation between clinical and tomographic variables in patients with neurocysticercosis in the neurology consultation of Hospital San Vicente de Paul and Hospital IESS Ibarra, during the year 2020. PATIENTS AND METHODS: descriptive, correlational and cross-sectional research. POPULATION AND SAMPLE: 93 patients. The information was collected in the neurology consultation. Clinical and imaging criteria were used for diagnosis. Odds Ratio (OR; 95% CI) was calculated. For multivariate analysis, binary logistic regression models were used. Statistical significance was considered when the value of p <0.05. SYMPTOMS: headache (77.4%), epilepsy (41.9%). Tomographic findings: size < 1 cm (67.7%), single lesion (54.8%), supratentorial (93.5%). There were several clinical / tomographic correlations in the bivariate analysis, the presence of epilepsy was associated with lesions of size >1 cm (OR: 9.65; 95% CI: 3.48-26.7), the vesicular + ventricular colloidal stage + nodular (OR: 3.90; 95% CI: 1.64-9.28) and parenchymal topography (OR: 5.03; 95% CI: 2.03-12.4) (p < 0.05). In the multivariate analysis, epilepsy was not associated with tomographic aspects such as the size, stage and topography of the cysticerci (p < 0.05). Headache and reduced muscle strength were associated with parenchymal topography and stage of lesions respectively (p < 0.05). CONCLUSIONS: Despite having a wide clinical spectrum, the presence of epilepsy, headache, and reduced muscle strength seem to be the most representative manifestations, so their inclusion in the development of prognostic scores should be evaluated, which allow evaluating the approach diagnostic and evolutionary in subsequent research.

TITLE: Correlación entre variables clínicas y tomográficas en pacientes con neurocisticercosis. Estudio en una cohorte de pacientes de la Sierra Norte ecuatoriana entre 2019 y 2020.Introducción. La neurocisticercosis es la enfermedad parasitaria más frecuente en el sistema nervioso central de los humanos. Objetivo. Establecer la correlación entre variables clínicas y tomográficas en pacientes con neurocisticercosis en la consulta de neurología del Hospital San Vicente de Paúl y el Hospital Instituto Ecuatoriano de Seguridad Social de Ibarra durante 2020. Pacientes y métodos. Investigación descriptiva, correlacional y transversal. Población y muestra: 93 pacientes. La información se recolectó en la consulta de neurología. Para el diagnóstico se utilizaron criterios clínicos e imagenológicos. Se calculó la odds ratio (OR) ­intervalo de confianza al 95% (IC 95%)­. Para el análisis multivariado, se utilizaron modelos de regresión logística binaria. Se consideró significación estadística cuando p menor de 0,05. Resultados. Síntomas: cefalea (77,4%) y crisis epilépticas (41,9%). Hallazgos tomográficos: tamaño menor de 1 cm (67,7%), lesión única (54,8%) y lesión supratentorial (93,5%). Hubo varias correlaciones clinicotomográficas en el análisis bivariado: la presencia de crisis epilépticas se asoció con lesiones de tamaño > 1 cm (OR: 9,65; IC 95%: 3,48-26,7), el estadio vesicular + ventricular coloidal + nodular (OR: 3,9; IC 95%: 1,64-9,28) y la topografía parenquimatosa (OR: 5,03; IC 95%: 2,03-12,4) (p menor de 0,05). La cefalea y la reducción de la fuerza muscular se asociaron con topografía parenquimatosa y estadio de las lesiones, respectivamente (p menor de 0,05). Conclusiones. A pesar de cursar con un amplio espectro clínico, la presencia de crisis epilépticas, cefalea y reducción de la fuerza muscular parece ser la manifestación más representativa, por lo que debería evaluarse su inclusión en el desarrollo de puntuaciones pronósticas que permitan evaluar el enfoque diagnóstico y evolutivo por estudio de imagen en investigaciones posteriores.

Cochlear morphometry in healthy ears of a mexican population: A comparison of measurement techniques.

OBJECTIVE: This study describes the cochlear morphometry of a mexican population analysed by laterality and sex. The objective is to compare Cochlear Length (CL) evaluation between Alexiades et al. formula and manual method described by Würfel et al. PATIENTS: Hispanic patients from Mexico, with an age of 18 years or older, were included. Morphometric examination was performed retrospectively on 200 subjects who underwent previously temporal bone imaging for clinical purposes. MATERIALS AND METHODS: Horos for Mac program was used to measure CL, cochlear height, distance A, and distance B. WorkStation AW Volume Share 2 was used to obtain volume. CL was measured in 400 temporal bones (228 females, 172 males). RESULTS: The mean CL was 34.02mm±2.15mm. A significant difference was found in all variables between sex (P=≤0.05) and laterality (P=≤0.05). The Alexiades equation was used for determining CL and compared with the manual formula, with no significant differences (κ=0.71). However, the time consumption was 5 times faster with the calculated method. The Alexiades formula was demonstrated to be a reliable method measurement. CONCLUSION: Preoperative Computed Tomography evaluation of the internal ear helps to plan the Cochlear Implants (CI) surgical approach and allows to choose an appropriate electrode length for each necessity. Our findings may be useful to facilitate and adapt preoperative management of CI surgery by considering the characteristics of cochlear morphology of Latin-American populations.

A proposed extension to the elongated styloid process definition: A morphological study with high-resolution tomography computer.

The objective of the present study was to evaluate the morphology and angulation of the styloid process (SP), analyzing results stratified by gender, side and age on asymptomatic patients. We retrospectively analyzed 99 high-resolution computed tomography study images from asymptomatic patients. The images were assessed intra-observatory by a head and neck expert radiologist. Data for length, morphology, and angulation in a coronal and sagittal plane were recorded and stratified by age and gender. Morphology was classified according to the Langlais modified by Guimares classification. The mean lengths were 31.67±0.97mm and 31.64±0.90mm for the right and left sides respectively. Using the Langlais modified by Guimares classification, the normal type was the most prevalent and without a statistically significant difference when comparing between genders. A total of 27.6% presented a morphologically elongated SP (>25mm of continuous process), 49.5% presented a radiologically elongated SP (>30mm), and a total of 9.59% had a longer length than the proposed≤45mm. The right transverse angle was greater in men than women, and a statistically significant difference was found (P=0.010). We show the morphological variability of the SP. Although our results are reported with the traditional definition, the high prevalence supports the need for a new definition of elongated SP and a normal angulation ranges.

[Surgical management of anterior cavas foot in Charcot-Marie-Tooth patients. Five-year follow-up]. / Manejo quirúrgico del pie cavo anterior en pacientes con Charcot-Marie-Tooth; evolución a 5 años.

UNLABELLED: Hereditary sensorimotor neuropathy involves foot deformities such as varus and cavus foot and claw toes. Several surgical techniques have been described to treat Charcot-Marie-Tooth disease. OBJECTIVE: To assess the clinical and functional result of "V" basal osteotomy of the central metatarsals with elevation of the first metatarsal, dorsal osteotomy plus closing osteotomy, and elevation of the fifth metatarsal in Charcot-Marie-Tooth patients during a five-year period. MATERIAL AND METHODS: Prospective, randomized, longitudinal, observational and descriptive study conducted during a five-year period. Twenty-four patients met the inclusion criteria: 16 males and 8 females. Seven underwent the surgical procedure in the right foot, seven in the left, and 10 in both feet, for a total of 34 feet treated. Results: The Pearson correlation coefficient was -0.1 and T = 1.71. A statistically significant difference was seen between the variables, which meant that, in the six-month follow-up, surgical treatment had representative benefits. CONCLUSIONS: The study found a statistically significant value for function, pain and alignment in patients who underwent surgical treatment, compared with their status prior to surgery. It is therefore recommended to continue using this technique in all patients presenting with anterior cavus foot.

[Delays in the arrival of patients with subarachnoid haemorrhage at a tertiary hospital]. / Demora en la llegada de pacientes con hemorragia subaracnoidea a un hospital terciario.

INTRODUCTION: Patients with subarachnoid haemorrhage should be referred to a tertiary hospital as early as possible. The aim of this research was to study how long these patients take to reach a tertiary care centre in Havana. PATIENTS AND METHODS: We conducted a prospective study of patients with subarachnoid haemorrhage who were admitted to the Stroke Unit at the Hospital Hermanos Ameijeiras between January 2005 and December 2007. The time of arrival at the hospital was determined and a comparison was carried out between patients who arrived after 72 hours and those who reached the hospital sooner. RESULTS: The sample studied comprised 94 patients. Only 34 (36%) arrived during the first three days, whereas 13 (13.8%) reached the hospital within the first 24 hours. None of the sociodemographic and clinical variables that were studied was associated with early remission. The length of time spent in hospital by patients admitted during the first 72 hours was 14.9 days, while in the other cases it was 17.57 days (p = 0.248). The greatest impact on early remission to the tertiary centre was on the outcome at discharge on the Rankin scale, which was lower in those who arrived early compared to the rest of the cases (p = 0.05); the same was true of mortality, which was 5.9% in those who arrived within the first 72 hours versus 11.7% in the others (p = 0.04). CONCLUSIONS: Only a third of the cases reached hospital during the first 72 hours and this group had a more favourable course.

Oocyte structure and ultrastructure in the Mexican silverside fish Chirostoma humboldtianum (Atheriniforme: Atherinopsidae)

The structural and ultrastructural features of gonads from endemic Mexican fish have received scarce attention. This study describes the histological and ultrastructural characteristics of oocyte from Chirostoma humboldtianum. The ovary is asynchronic, and as such, most phases of oocyte development are found in the same ovary. The complete process of oogenesis was divided in five stages: oogonium and folliculogenesis, primary growth, cortical alveoli and lipid inclusions, vitellogenesis, and maturation. The presence of big filaments, which appear at the end of primary growth, induces some common follicular adaptation. During primary growth, abundant ribosomes, the rough endoplasmic reticulum, and mitochondria are grouped in the cytoplasm. At the end of this stage, the Z1 layer of the chorion is developed, while microvilli start to be evident. In the cortical alveoli and lipid droplets phase, intense PAS positive vesicles, some of them containing nucleoid material, are observed in the peripheral cytoplasm and the lipid droplets take a more central position. In vitellogenesis, the proteic yolk accumulates in a centripetal way while the chorion is completely formed. During maturation, the germinal vesicle migrates to the animal pole, meiosis is restored, and there is nuclear breakdown. The oocyte increases its size and holds some oil droplets and a big fluid mass of yolk. On the outside, filaments completely surround the oocyte. Rev. Biol. Trop. 56 (3): 1371-1380. Epub 2008 September 30.

Oocyte structure and ultrastructure in the Mexican silverside fish Chirostoma humboldtianum (Atheriniforme: Atherinopsidae).

The structural and ultrastructural features of gonads from endemic Mexican fish have received scarce attention. This study describes the histological and ultrastructural characteristics of oocyte from Chirostoma humboldtianum. The ovary is asynchronic, and as such, most phases of oocyte development are found in the same ovary. The complete process of oogenesis was divided in five stages: oogonium and folliculogenesis, primary growth, cortical alveoli and lipid inclusions, vitellogenesis, and maturation. The presence of big filaments, which appear at the end of primary growth, induces some common follicular adaptation. During primary growth, abundant ribosomes, the rough endoplasmic reticulum, and mitochondria are grouped in the cytoplasm. At the end of this stage, the Z1 layer of the chorion is developed, while microvilli start to be evident. In the cortical alveoli and lipid droplets phase, intense PAS positive vesicles, some of them containing nucleoid material, are observed in the peripheral cytoplasm and the lipid droplets take a more central position. In vitellogenesis, the proteic yolk accumulates in a centripetal way while the chorion is completely formed. During maturation, the germinal vesicle migrates to the animal pole, meiosis is restored, and there is nuclear breakdown. The oocyte increases its size and holds some oil droplets and a big fluid mass of yolk. On the outside, filaments completely surround the oocyte.

Placental immaturity and hyperinsulinaemia in full-term newborns.

BACKGROUND: Evidence from large studies suggests that low birthweight is a risk factor for cardiovascular disease and glucose metabolism disorders in adulthood, but the physiological mechanisms involved in intrauterine growth conditioning low birthweight are not completely understood. The objectives of this study were to determine whether placental immaturity (PI), defined as the lower quartile of placental maturity index (PMI), is associated to hyperinsulinaemia at birth and to identify the risk factors associated with PI. MATERIALS AND METHODS: Cross-sectional study conducted at medical research units of two Mexican general hospitals. A total of 272 full-term newborns with gestational age >/= 38 and < 41 weeks were allocated into the corresponding group according to the quartile distribution of PMI. Data from the lower (PMI < 13.3) and higher quartile (PMI >/= 24.3) were compared. The PMI was estimated by dividing the number of epithelial plates by the average thickness of the epithelial plate. Serum measures included cord glucose and insulin levels of the newborns at birth. RESULTS: A total of 74 (27.2%) children had hyperinsulinaemia at birth, of them 47 (63.5%) with PI. The adjusted multiple regression analysis showed a strong association between PI and hyperinsulinaemia at birth [odds ratio (OR) 2.6; CI 95% 1.3-4.3). Additional adjusted analysis showed that both mother's age

[Transsphenoidal approach to prolactinomas]. / Cirugia transeptoesfenoidal en adenomas hipofisarios productores de prolactina.

INTRODUCTION: Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique. In particular the use of medical treatment in patient with prolactinomas has induced the control of hiperprolactinemia and the shrinkage of the tumor in the great majority of the patients, for that reason the treatment of the prolactinomas is controversial. OBJECTIVE: We evaluate the results of transsphenoidal microsurgical treatment of prolactin secreting adenomas at our Unit. METHODS: We made a retrospective analysis of 63 patients operated on via transsphenoidal microsurgical technique for prolactin secreting adenomas between 1996 and 2003. Age, sex, symptoms, tumor size, hormonal levels, complications and postsurgical outcome were considered. RESULTS: There was a female predominance of 86% of the cases and middle aged patients were more commonly seen. 31 patients had tumors more than 10mm in diameter on the CT scan. The most frecuent complication was transient diabetes insipidus (11 cases). Prolactin levels were reduced to non tumoral values in 90.6% of microadenomas (29 cases) and in 67.7% of macroadenomas (21 cases). Headache was the most frecuent complain in our patients with amelioration after surgery in 82% (36 cases). Campimetric visual defects were reduced in 69% (18 cases). CONCLUSIONS: Transsphenoidal adenomectomy is a safe treatment option for patients with prolactin secreting adenomas with surgical indication.

Cirugìa transfenoidal en adenomas hipofisiarios productores de prolactina / Transsphenoidal approach to prolactinomas

Para un gran nùmeros de tumores pituitarios, la cirugpia es el tratamiento de primera lìnea y el abordaje trnasfenoidal microquirurgico, el proceder màs utilizado...(AU)

Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique...(AU)

[Transnasal-transsphenoidal endoscopic surgery of the sellar region]. / Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar.

UNLABELLED: Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. OBJECTIVES: To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach. MATERIAL AND METHODS: As the first stage of a three stage randomized trial, this is a prospective study of 10 patients operated on, using transnasal transsphenoidal endoscopic approach between august 2002 and August 2003 at the department of neurosurgery of "Hermanos Ameijeiras Hospital". RESULTS: Six patients had pituitary macroadenomas and four had cerebrospinal fluid leak through the sellar floor. In five of six macroadenomas total tumor resection was obtained and in the other one a subtotal resection was performed. Two of four patients with cerebrospinal fluid leak could be cured while the other two patients do not. Complications were present in 30% of cases, but in only 1 (10%) it reached the postoperatory period. CONCLUSIONS: Transnasal transsphenoidal endoscopic approach to the sella can be done save enough in our Hospital to justify the start of the second stage of one randomized trial to determine if the endoscopic technique is better than the usual transsphenoidal approach.

Cirugìa transnasal transesfenoidal endoscòpica en afeciones de regiòn selar / s. t

Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach...(AU)

Combined therapy in the treatment of primary mediastinal B-cell lymphoma: conventional versus escalated chemotherapy.

Treatment of patients with primary mediastinal B-cell lymphoma (PMBCL) remains controversial. We started a controlled clinical trial to evaluate the efficacy and toxicity of a conventional versus more intensive regimen of combined chemotherapy followed by radiotherapy to the mediastinum with the mantle technique. From 1989 to 1997, 68 patients diagnosed with previously untreated PMBCL, aged 18-65 years and negative for immunodeficiency virus test, were considered candidates to receive either conventional chemotherapy with CEOP-Bleo (cyclophosphamide 750 mg/m(2), vincristine 1.4 mg/m(2), prednisone 40 mg/m(2), epirubicin 70 mg/m(2), and bleomycin 10 mg/m(2)) or mega CEOP-Bleo (cyclophosphamide 1000 mg/m(2), epirubicin 120 mg/m(2), vincristine, prednisone, and bleomycin at the same doses) every 21 days for six cycles, followed by radiotherapy to the mediastinum with the mantle technique (35-45 Gy, mean 38 Gy). Complete response (CR) rates were not statistically different: 64% [95 percent confidence interval (CI): 58 percent to 70 percent] for conventional arm vs 81 percent (95 CI: 77-86 percent) in the intensive group (p=0.2). However, failure-free survival (FFS) and overall survival (OS) had statistical differences. At 5 years, actuarial FFS for patients treated with conventional chemotherapy was 51 percent (95 percent CI: 44-59 percent) compared to 70 percent (95 percent CI: 65-76 percent) in the intensive arm (p>0.01). OS rates were also different: 54 percent (95 percent CI: 48-57 percent) vs 70 percent (95 percent CI: 65-76 percent), respectively (p<0.01). Toxicity was mild and no therapy-related deaths were observed. At a median follow-up of 7.3 years, no second neoplasia or acute leukemia has been observed. The international prognostic index was not useful to define clinical risk in this selected group of patients. Multivariate analysis identified pleural and pericardial effusion and chemotherapy regimen as prognostic factors influencing FFS and OS. We feel that patients with PMBCL should be treated with more intensive, but not myeloablative chemotherapy, followed by adjuvant radiotherapy to achieve an improvement in outcome in this setting of patients. Patients with pleural or pericardial effusion are considered at high risk for failure with the actual programs of treatment and probably will be considered for experimental therapeutic approaches.

[Effect of oral contraceptive administration on the frequency of estrogen receptor and cervical intraepithelial neoplasia]. / Influencia de la administración de anticonceptivos orales sobre la frecuencia de receptor estrogéncio y neoplasia intraepitelial cervical.

A study of 56 sexual active women with cervical intraepithelial neoplasia (CIN) was conducted in Mexico City, to determine wether the risk for this condition is altered by using oral contraceptives. Responses of a standardized questionnaire compared 29 patients under oral contraceptive (OC) treatment and 27 control subjects selected from the same screening program, though which the cases were detected. Estrogen receptor (ER) levels were determined in each hyperplastic tissue. The ER frequency was approximately the same in women under oral contraceptive (OC) treatment and in women without it. (P > 0.05). Among other risk factors, first intercourse at an early age, first pregnancy age, number of pregnancies and multiple sexual partners were consistently no significant (p > 0.05) when both groups were compared. In this study, we have found no evidence of an etiologic relationship between neither oral contraceptive usage or non usage and CIN.