[Overuse of colposcopy service in Mexico]. / Sobreutilización del servicio de colposcopia en México.

BACKGROUND: Cervicouterine cancer is one of the main public health problems in Mexico. Several problems related to the low effectiveness of the Program of Opportune Detection of Cervicouterine Cancer have been identified, among them: low cover of the disease detection and absence of quality control in the detection, diagnosis and treatment of it. In Mexico the quality control problem in cytology has been taken with success, but the opposite occurs with colposcopy practice. For that reason this service is overused by patients with low risk cancer and is not accessible for the high risk population. OBJECTIVE: To evaluate the association between cervicouterine cancer knowledge and satisfaction with the service regarding the use and intention of adherence to it for the follow-up and treatment, as well as analyze the resources used for this attention. PATIENTS AND METHODS: A transversal study was done from May to December, 2002. It included all the patients who went to the Colposcopy Service in three hospitals. 1,606 patients were interviewed, from them 443 cases were first-time visits and 1,163 were subsequent ones. RESULTS: In a multivariate model we observed that the real utility knowledge of cervicovaginal cytology increases the probability that women come back to the Colposcopy Service (OR 2.0, Cl 95%: 1.57, 2.54). Patients who know their diagnosis when it is dysplasia or cancer are more likely to become attached to their follow-up than those who do not know it. 91% of the users (1,463) had two or more cervicovaginal cytolgies done, and 49% (787) had eight or more. Patients who know the purpose and utility of the biopsy had a 4.4 fold probability of become subsequent than those that do not know such information (Cl 95%: 1.72 to 11.35). CONCLUSIONS: Nowadays colposcopy clinics treat 70% of the patients who are subsequent and that have normal reports of cytology. This shows us an overuse of the service, with the consequent service, monetary and opportunity costs for women. More studies should be done to reformulate the rule that controls the treatment of these patients, and incorporate follow-up guidelines according to the natural history of the disease in Mexican women.

[Vulvar intraepithelial neoplasm]. / Neoplasia intraepitelial de la vulva.

BACKGROUND: Vulvar intraepithelial neoplasia is a challenge for the physician as it is asymptomatic and it can evolve to malignant disease. A high suspicion index, as well as some biopsies are necessary, provided an early invasive disease can exist. OBJECTIVE: To establish the patient's characteristics with vulvar intraepithelial neoplasia, seen at the Clinica de Especialidades de la Mujer, SEDENA. PATIENTS AND METHODS: An observational and retrospective analysis was done from February 1st, 1990 to December 31st, 2004. We used the data base of the Hospital Central Militar and of the Clinica de Especialidades de la Mujer, SEDENA. We identified patients with vulvar intraepithelial neoplasia or in situ vulvar cancer diagnosis. We assessed the following variables: patient's age, intraepithelial neoplasia or history of cervical cancer, acuminated vagina or condylomas, prescribed treatment and current health state. RESULTS: We identified 38 patients with ages between 49 and 82 years old. Patients with intraepithelial neoplasia I were the youngest, except one, whom at the moment of the diagnosis had 58 years old. The histopathological diagnosis was of intraepithelial neoplasia type I (koilocytotic atypia) in 10 cases, type II in 10 more, and type III in 18 of them. CONCLUSIONS: Treatment should be individual for each patient. In most of the cases and due to the high recurrence rates we prefer the conservative treatments.

Tratamiento de condiloma acuminados gigantes de la vulva combinando láser CO2 y electrocirugía / Treatment for large papilomas of the vulva, combining laser CO2 and electrosurgery

Dado que no existe a la fecha tratamiento antiviral para el virus del papiloma humano (VPH), el papel del médico es tratar todas las lesiones clínicas para ayudar al sistema inmune del paciente a luchar en contra del virus y prevenir la transmisión; dado que se sabe que el VPH se transmite al tener contacto con las lesiones. Las lesiones asociadas a VPH han sido tratadas con una variedad amplia de métodos que pueden ser divididos en químicos, quirúrgicos y estimulantes de la inmunidad. Debido al gran tamaño de las lesiones en los casos referidos en este artículo se empleó una combinación de electrocirugía y vaporización láser CO2.

Esquema corto de antibióticos en el tratamiento de endometritis posterior a cesárea / Antibiotics short course in post-cesarean endometritis treatment

La terapia antimicrobiana común después de una endometritis posterior a cesárea consiste en el tratamiento intravenoso inicial seguido por una terapia oral o intramuscular hasta completar 7 a 10 días. En un esfuerzo para reducir la duración del tratamiento, se realizó un estudio comparativo, aleatorio, del 1o. de noviembre de 1993 al 31 de mayo de 1994, entre el tratamiento convencional de la endometritis poscesárea manejado en el Hospital Central Militar (esquema largo) contra un esquema corto, parenteral, con los mismos antibióticos, hasta conseguir la remisión del cuadro clínico. De las pacientes tratadas con esquema corto (32) sólo una presentó persistencia de la infección al ser revisada a los 10 días de iniciado el tratamiento. En quienes recibieron el esquema largo (31) no hubo ninguna complicación (p>0.05). En el grupo con esquema corto se redujo el número de días de tratamiento y los costos de éste así como las molestias producidas por la aplicación intramuscular de los antibióticos. Esta observación sugiere que un curso corto de antibióticos basado en una buena respuesta médica, puede ser una alternativa segura y poco costosa en el tratamiento de estas pacientes