Pronóstico del cáncer de cérvix en un hospital de área / Prognostic factors and outcome of cervical cancer in a district hospital

Objetivo: Analizar las características clinicopatológicas de las pacientes diagnosticadas de cáncer invasivo de cérvix en nuestro ámbito clínico, así como su evaluación pronóstica. Sujetos y métodos: Estudio retrospectivo observacional de todas las pacientes con diagnóstico histológico de cáncer invasivo de cérvix en nuestro servicio hospitalario durante el período 1994-2003. Se recogen las características clínicas de las pacientes y de los tumores. Se establecen las curvas de supervivencia según el método de Kaplan-Meier y se comparan mediante la prueba de rangos logarítmicos para el análisis univariante. El análisis multivariante se realizó mediante la regresión de Cox. Resultados: Se identificaron 39 pacientes con una media de edad de 54 años. La mayoría presentaba metrorragias y se encontraba en un estadio inicial (66%) en el momento del diagnóstico. El 84% de los tumores fueron escamosos, moderadamente diferenciados (56%) y sin invasión linfovascular (87%). El tratamiento fue preferentemente radioterapéutico (48%). Los factores pronósticos para la supervivencia global fueron el estadio clínico (p < 0,001), el valor de hemoglobina (p = 0,007) y el grado histológico (p = 0,01). Sólo el estadio se mantuvo como factor pronóstico independiente (p = 0,001) en el análisis multivariante. Conclusiones: Nuestros resultados resaltan la importancia de un diagnóstico precoz del cáncer de cérvix

Objective: To analyze the clinical and pathologic characteristics of invasive cervical cancer in our center and to identify prognostic factors. Subjects and methods: We performed an observational, retrospective study of all women with a histopathological diagnosis of invasive cervical cancer in our department between 1994 and 2003. Clinical and tumoral characteristics were included. Survival curves were calculated with the Kaplan-Meier method and were compared with the log rank test. Multivariate analysis was performed using the Cox regression model. Results: Thirty-nine patients were identified. The mean age was 54 years. At diagnosis, most of the patients showed abnormal bleeding and initial-stage tumors (66%). Thirty-three tumors (84%) were squamous, 22 were moderately differentiated (56%) and 34 showed no lymphovascular invasion (87%). The most frequent treatment was radiotherapy (48%). Prognostic factors for overall survival were clinical stage (p < 0.001), pre-treatment hemoglobin levels (p = 0.007) and histologic grade (p = 0.01). The only independent prognostic factor in the multivariate analysis was clinical stage. Conclusions: Our results emphasize the importance of an early diagnosis in invasive cervical cancer

Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine.

STUDY DESIGN: This is a case report. OBJECTIVES: To provide a better understanding of a rare entity, ligamentum flavum hematoma, based on a successfully treated patient. SUMMARY OF BACKGROUND DATA: Lumbar root compression is frequently caused by disc herniation. Canal stenosis, epidural hematoma, or tumors are less common. Few cases of hematoma in the ligamentum flavum causing lumbar root compression have been described. METHODS: A patient was treated for ligamentum flavum hematoma causing progressive lumbar root symptoms. Clinical and radiologic features, including magnetic resonance images, were recorded. RESULTS: Symptoms consisted of progressive lumbar root deficit after mild physical exertion. On magnetic resonance images, a mass continuous with the ligamentum flavum, compressing the dural sac and roots, was found. Areas of high signal in T1 were present in it. In this patient, removal of the ligamentum flavum (degenerated tissue containing hematoma) resolved all of the symptoms. The diagnosis could have been suspected based on clinical history and magnetic resonance imaging. CONCLUSIONS: Magnetic resonance imaging can provide a basis for diagnosing ligamentum flavum hematoma. Removal of ligamentum flavum is the treatment of choice.