Mauricio Cuello F

REDUCCIÓN DE LA MORTALIDAD POR CÁNCER CÉRVICO UTERINO EN CHILE, 1990-2003

SUMMARY Objective: To analyze the effect of the National Program for Cervical Cancer on the mortality trend due to this cancer in Chile during 1990-2003, and the feasibility to achieve a 40% reduction in mortality rate at the year 2010. Methods: The number of deaths due to cervical cancer, the age interval of the deceased women, and the estimate of women population were obtained from the Year Book edited by the National Institute of Statistics of Chile. The gross and age-adjusted mortality rates were calculated using year 2003 as a standard of population number. The trend and the slope for the period, and the estimated number of deaths at year 2010 were calculated using linear regression. Results: A significant descending trend for the adjusted death rate was observed when comparing years 1990 and 2003 (from 14.3/100,000 in 1990 to 8.5/ 100,000 in 2003, r=‐0.977; p<0.001). The slope for the period showed a yearly reduction in rate of 0.463/ 100,000 women, estimating for year 2010 a mortality rate about 4.8/100,000 women, lower than the objective proposed by the Public Health Ministry of Chile. Conclusions: The introduction of a National Program for Cervical Cancer has allowed reducing significantly the mortality rate due to this cancer between

Biopsia rápida por congelación en el diagnóstico de tumores de ovario: correlación diagnóstica según diámetro y peso en tumores de origen epitelial

Background: Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary a high level of accuracy. Aim: To evaluate the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight. Patients and methods: Retrospective study of frozen-sections performed in patients with ovarian tumors who underwent surgery. Frozen- and permanent- sections were divided into three categories (benign, borderline and malignant) and stratified by diameter ( 20 cm) and weight ( 1400 g). The diagnostic correlation, sensitivity, specificity, predictive values and accuracy of each frozen-section diagnosis were determined. Results: Eight hundred forty two ovarian tumors that underwent frozen-sections between January 1988 and October 1998 were studied. Final diagnosis was 86,7% benign, 2,7% low malignant potential (LMP) and 10,6% malignant. The diagnosis correlation between frozen- and permanent-sections was 98,2%. Misdiagnosis was in epithelial ovarian tumors, particularly in LMP tumors. Sensitivity, specificity, positive- and negative- predictive values and accuracy of the four hundred eighty nine epithelial tumor were 92,6%, 99,2%, 96,7%, 98,2% and 97,9%, respectively. Diagnostic correlation was higher in epithelial ovarian tumors with diameter 10 cm or weight >700 g (particularly in LMP tumors) is difficult because of the extensive sampling required. Frozen-sections diagnoses are important to determine the type and extent of surgery performed at the initial operation.

MORTALIDAD POR CÁNCER EN LA MUJER CHILENA: ANÁLISIS COMPARATIVO ENTRE LOS AÑOS 1997 y 2003

SUMMARY Background: Cancer is the second cause of death in developed countries and shows a continuous reduction in rate independently of sex and race. Objectives: To compare the cancer mortality rate observed among Chilean women and establishing the main localizations causing death in that group in 1997 and 2003. Material and Methods: The cancer mortality rate was calculated using the total number of cancer deaths and the estimated women population obtained from the vital statistical reports of 1997 and 2003. Results: Between 1997 and 2003, it was a significant increase in overall cancer mortality rate among women. In both years, the five more frequent causes of cancer death were: breast, stomach, gallbladder, lung, and cervical cancer; among them, breast cancer increased and cervical cancer decreased, both significantly; the others did not experience significant rate changes. There were significant increases in other less frequent cancers such as: colon, pancreas, ovarian, non-Hodgkin lymphoma, myeloma, brain, bladder, and lymphatic leukemia. Conclusions: Overall, there has been an increase in oncologycal mortality rate in Chilean women. With the exception of cervical cancer, the majority of the more frequent cancers have increased their mortality rate. This increasing mortality trend enforces to review the quality of the data registration, the existing health programs, and designing new strategies which will lead us to improve prevention, access, and quality of treatment, and finally to decrease cancer mortality. New strategies such that incorporated in Law 19,996 are called to change current outcomes.

Efectos de las estatinas en cáncer: ¿potencial rol en terapéutica y prevención?

This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.

TUMOR OVARICO EN LA POSTMENOPAUSIA: CONSIDERACIONES SOBRE SU MANEJO ACTUAL

Se presenta una serie de 234 pacientes postmenopausicas mayores de 50 anos con diagnostico de tumor ovarico operadas en nuestro centro. Aproximadamente 60% de los casos fueron hallazgo del examen, ecografia o de la cirugia. Las pacientes fueron mayoritariamente abordadas por laparotomia (89%). Solo en 25 casos se realizo laparoscopia no registrandose casos de tumor maligno. En un 23% de los casos el diagnostico histologico fue el de cancer de ovario. En aquellos casos en que se realizo biopsia contemporanea (72,6%) hubo excelente concordancia (98,8%) con el diagnostico reportado en la biopsia definitiva. La tasa de complicaciones observada fue menor al 10% (con menos de un 5% de complicaciones graves). De interes resulta el que no se observaron tumores malignos en lesiones ovaricas con diametro ultrasonografico menor de 3 cm. Los hallazgos encontrados sugieren que el tumor ovarico en la postmenopausia no debe ser una indicacion perentoria de cirugia abierta. El seguimiento ecografico es factible en lesiones pequenas (menores de 3 a 5 cm), particularmente si las caracteristicas ecograficas sugieren benignidad y el CA-125 es negativo. Dada la frecuencia de tumores benignos, en casos bien seleccionados (por tamano, caracteristicas ecograficas y marcadores) y contando con biopsia contemporanea es posible realizar un abordaje por laparoscopia. En centros especializados la edad avanzada (> 70 anos) no debiese ser una contraindicacion a la cirugia

CONSIDERACIONES PARA EL USO DE LA LAPAROSCOPIA DURANTE EL EMBARAZO

RESUMENLos avances en laparoscopia tanto tecnologicos como medicos han hecho posible ampliar el espectrode patologias ginecologicas susceptibles de ser manejados por esta via. Condiciones medicas considera-das previamente como una contraindicacion a esta via, como el embarazo, son susceptibles de sermanejadas con seguridad y eficacia manteniendo los beneficios que esta tecnica ofrece. El presentearticulo revisa las indicaciones, recomendaciones, ventajas y desventajas de su uso durante el embarazo.PALABRAS CLAVES: Laparoscopia, embarazo, cirugia laparoscopica no ginecologicaSUMMARYTechnological and medical advances in laparoscopic surgery have made feasible to extent its use to awide variety of gynecological pathologies. Clinical conditions considered earlier as a contraindication for itsuse, such as pregnancy, are now susceptible to be managed securely and efficiently with this technique andmaintaining all the advantages described for it. The present publication reviews the main indications,recommendations to follow, benefits and disadvantages of its use during pregnancy.KEY WORDS: Laparoscopy, pregnancy, non-gynecologic laparoscopic surgery

DISTRIBUCIÓN DE LA PATOLOGÍA ANEXIAL EN MUJER CHILENA: EXPERIENCIA DE LA UNIVERSIDAD CATÓLICA DE CHILE

SUMMARY Distribution of anatomo-pathological findings in the adnexa is shown for patients operated of a gynecological pathology during the period between years 1991 and 2002. Its frequency is analyzed according to age, anatomic location and malignancy. Cancer risk in patients operated of adnexal mass is 9.5%. Incidental finding of cancer in patients operated of benign gynecological pathology is approximately 1 in 3000 cases (0.3%).

TUMORES ANEXIALES EN NIÑAS Y ADOLESCENTES: EXPERIENCIA DEL HOSPITAL CLÍNICO DE LA UNIVERSIDAD CATÓLICA DE CHILE, 1991-2003

SUMMARY A retrospective analysis of a thirteen years experience in the surgical management of adnexal mass in girls and teenagers younger than 19 years old was done. We reviewed the clinical course and pathological findings of 106 patients. A 62% of adnexal masses were due to neoplasic formation, the majority of them originated in the ovary. Among the neoplasic lesions, the risk of malignacy was 26.7%. The most frequent benign ovarian neoplasia was the mature teratoma (31.1%). The two more frequent malignant neoplasias were those originated at the specific gonadal stroma and at germinal tissues (together representing 37.5% of malignant tumors). The most frequent symptom of clinical presentation was abdominal pain, as manifestation of a complicated benign neoplasic lesion. The most frequently used surgical approach was laparotomy. The main goal was privileging conservative management to preserve the reproductive potential.

Tumor de celulas de sertoli y leydig del ovario

Se reporta el caso de una paciente de 16 anos con un tumor de celulas de Sertoli y Leydig del ovario en etapa I tratado con cirugia exclusiva. Ademas, se realiza una revision de la literatura sobre este tipo de tumor

Hiperandrogenismo avanzado en una mujer postmenopáusica. Caso clínico

We report a 76-year-old woman with a virilization syndrome characterized by progressive androgenic alopecia, clitoris enlargement and hirsutism predominating in the face. Plasma testosterone was 711 ng/dl. Magnetic resonance imaging showed slightly enlarged ovaries with a cyst in the left. A bilateral oophorectomy was performed, demonstrating the presence of a Leydig cell hilar tumor in the right ovary. The patient had a good postoperative evolution with reduction of androgen levels and reversion of alopecia.