Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi's sarcoma. A double blind, randomized clinical trial.

In this double-blind, randomized trial, we compared the clinical efficacy of intralesional vinblastine (VNB) and 3% sodium tetradecyl sulfate (STS) in the treatment of oral Kaposi's sarcoma (OKS). Subjects with OKS were randomly assigned to receive a single intralesional injection of either VNB or STS, at a standard dose (0.2 mg/cm(2)). Differences were evaluated by the Mann-Whitney U and Fisher's exact tests. Sixteen HIV-infected patients were included, eight received VNB and eight received STS; clinical response was evaluated at days 7, 14, and 28 following treatment. Tumor size reduction was 0.68 and 0.61 cm in the VNB and STS groups, respectively (P=0.80). Two VNB patients had complete or partial response whereas four STS subjects had partial responses (P=0.61). Patients in both groups experienced minimal toxicity. We conclude that intralesional vinblastine or STS are adequate for the management of OKS. The benefits of STS are its low cost and ease of use.

[Descriptive epidemiology cancer in the National Cancer Institute of Mexico]. / Epidemiología descriptiva de cáncer en el Instituto Nacional de Cancerología de México.

OBJECTIVE: To analyze the descriptive epidemiology of cancer at the Instituto Nacional de Cancerología of Mexico, and describe the characteristics of the growing demand for medical care. MATERIAL AND METHODS: A review of the 10 year experience of the Hospital Cancer Registry from 1985 to 1994 was done. RESULTS: During the study period a total of 28591 patients was registered with the histological confirmation of cancer. There were 8984 (31.4%) men, being the testicle (8.3%), the lung (7.4%), non-Hodgkin's lymphoma (7.1%) and the prostate (5.5%) the more frequent malignancies. In women a total of 19597 (68.6%) cases were seen; together, invasive cervical cancer (30.6%) and breast cancers (20.6%) represent more than 50% of all patients. In 1996, 108876 outpatient services were given, 6492 hospitalizations, 36388 sessions of radiotherapy and 9116 of chemotherapy. Only 30% of this population comes from Mexico City, the remaining lives in the 31 different states of Mexico. CONCLUSIONS: Supporting the development of the Centros Estatales de Cancerología for the referral of patients is necessary, this will avoid the rapid saturation of medical care at the institute. Also, stimulate the development of hospital registries and collaborate with the Ministry of Health to improve the early cancer detection programmes in Mexico.

Intestinal type: diffuse type ratio of gastric carcinoma in a Mexican population.

This study was performed in order to define the histological patterns of gastric carcinoma according to Lauren's classification and the IT:DT ratio in a Mexican population. We analyzed the relative frequency of intestinal-type and diffuse-type carcinomas in a group of patients, diagnosed at the Instituto Nacional de Cancerologia in Mexico City between 1982 and 1992. Of the 460 cases of gastric cancer, 242 (52.7%) were of the intestinal-type, 206 (44.7%) of the diffuse type, and 12 (2.6%) others. A predominance of the diffuse type among the younger age groups (< 50 years) was observed-the transitional age for men and women occurred in the sixth decade. The global intestinal: diffuse ratio was 1.2 and increased with age. This ratio remained similar during the 11 years of the analysis. Men had a higher proportion of intestinal type carcinoma than women. These findings indicate that Mexico is not a low risk area for gastric cancer with a consistently low intestinal: diffuse type ratio. Despite differences in geographic and demographic patterns, the intestinal and diffuse types of gastric carcinoma have common etiological factors.

Application of an autopsy report specifically designed for cardiovascular diseases.

After modifying the format and content of the autopsy report traditionally used at the Instituto Nacional de Cardiología of México, Tlalpan, we present the results of the new, revised autopsy protocol here. The new autopsy protocol (model report) was designed as a "fixed format" to describe the cardiovascular diseases observed at our institution, thus pretending to collect more and better data, providing useful information, and contributing to better clinicopathologic correlations. The comparison between the model and traditional reports demonstrated an improvement in the autopsy data collection system--achieving better clinicopathologic correlations of the main disease and the cause of death, and identifying morphologic alterations that would explain it in more cases. The model report was also considered more accessible and useful since it permitted the answering of more questions raised by clinicians.

[Antifoaming agent microembolism in patients undergoing extracorporeal circulation. Its frequency in post mortem material and its pathogenic potential in vitro]. / Microembolias de antiespumante en pacientes sometidos a circulación extracorpórea. Frecuencia en material post mortem y su potencial patógeno in vitro.

Antifoam microembolisms in patients that undergo open heart surgery, represent a risk for postoperative complications. We decided to study its frequency in an autopsy population of patients who died after heart surgery. Forty-five patients were selected and histological sections from the kidneys were studied under light microscopy, scanning electron microscopy and X-ray microanalysis. Thirty-six cases (80%) showed microemboli in the glomerular capillaries lumens. There was a positive correlation between the number of particles found and the length of the surgery. Microemboli were composed of an amorphous fraction and a particulated one composed of silicon. In vitro experimentation demonstrated that the particles are capable to induce cell lysis in a dose related manner. They also are susceptible of been phagocitated by macrophages. We conclude that bubble oxygenator are capable to induce microembolisms in a high percentage of the cases studied. Components of the microemboli are cytotoxic. Therefore microembolisms could be participating in the morbidity of patients subjects to cardiopulmonary bypass.

[Rupture of the middle left ventricle after a mitral valve replacement. A report on 27 autopsy cases]. / Rotura de la porción media del ventrículo izquierdo después de reemplazo valvular mitral. Comunicación de 27 casos de autopsia.

Left ventricular rupture is a serious complication of mitral valve replacement. The prevalence ranged from 0.5 to 14%, and is the principal cause of early postoperative death following mitral valve replacement. In this report we described certain morphologic observations and some clinical and epidemiological data of a series of 27 necropsy patients with midventricular rupture (type III). This complication was predominantly present in females (88.9%) with an average age of 44 +/- 11.4 years. The predominant valvular lesion was stenosis (70.4%). In all cases we found small-sized left ventricles and the ventricular wall hypertrophied. Perforation was observed in the 18.5% of the cases. In 59.2% of the patients high profile prostheses were used. Seventy-eight percent of patients died before 24 hours with refractory ventricular failure and only in the 25.9% of cases the clinical diagnoses was suspected and rupture unsuccessfully repaired. Our results suggested that age, sex, type of mitral lesion, ventricular size and type of prostheses are not risk factors for this complication. The mortality is high and the diagnosis was not suspected frequently. Midventricular rupture of the left ventricle is a lethal complication and is necessary to know all its characteristics to implement better methods of prevention and management.

[Myocardial infarct and rupture of the left ventricular free wall. Some considerations on incidence, morphological characteristics and risk factors]. / Infarto del miocardio y ruptura de la pared libre del ventrículo izquierdo. Algunas consideraciones sobre la frecuencia, características morfológicas y factores de riesgo.

Rupture of the left ventricle free wall is a sudden and unexpected event in myocardial infarction. It is considered the third most common cause of death, following cardiogenic shock and arrhythmias. The frequency of rupture varies because many patients may survive the initial insult of myocardial infarction. Conflicting reports regarding risk factors have been published by several authors. With these considerations in mind, the present investigation was undertaken to evaluate ventricular rupture in an autopsy population from the Instituto Nacional de Cardiología. We analyzed the salient morphologic features and the risk factors. Our results indicated an incidence rate of 17.7% of cardiac rupture in patients who died of acute myocardial infarction and were autopsied. Ruptures are more common in elderly female patient during their first infarct, they were localized preferentially in the anterior wall and occurred within the first four days after infarction. Chance of rupture was greater in hypertensive patients, whereas a history of previous infarct protected against this contingency.

[Cardiovascular pathology and the partial autopsy. The experience at the Instituto Nacional de Cardiología Ignacio Chávez of Mexico]. / La patología cardiovascular y la autopsia parcial. Experiencia en el Instituto Nacional de Cardiología Ignacio Chávez de México.

There is no doubt autopsies are still a powerful source of medical information. At the Instituto Nacional de Cardiología de México 50% of deaths are autopsied. About half are limited cardiothoracic studies. Since no previous evaluation of the utility of the information obtained from those limited necropsies, we decided to test how well they allowed for a good clinical and anatomical correlation of main disease and a cause of death, as well as their potential to respond clinical questions relevant to the case. We analyzed the medical and autopsy records from 50 cases and determined autopsy type (limited or total), age, sex, main disease and cause of death. It was also included a list of questions made by the attending physician who asked for autopsy. Twenty-six cases corresponded to limited autopsies. In 96.1% there was a good anatomical and clinical correlation of main disease. In 69.2% the cause of death had also a good correlation and in 92.3% of the cases the clinician's question were answered appropriately. Based in our results we support the idea that cardiovascular limited autopsies are an alternative way to obtain useful information, when otherwise, total autopsies result expensive or difficult to obtain.

[Autopsy: reflection of intrahospital mortality]. / La autopsia, espejo de la mortalidad Intrahospitalaria.

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.