Revista Medica Herediana

Screening in cancer: utility of PSA in the detection of prostate cancer

Eficacia del examen digital rectal de la próstata y antígeno prostático específico en la detección del cáncer de próstata

Objetivo: Evaluar la eficacia del Examen Digital Rectal (EDR) y del Antígeno Prostático Específico (APE) en la detección del cáncer de próstata. Material y métodos: Se realizó un estudio retrospectivo en el Hospital Nacional Cayetano Heredia (HNCH) durante el período 1977 y 1999. Se revisaron las historias clínicas de pacientes que acudieron al Servicio de Urología con sintomatología prostática y que cumplieron con los criterios de inclusión. La eficacia de las pruebas diagnósticas se evaluó con la sensibilidad, especificidad , valor predictivo positivo (VPP) y valor predictivo negativo (VPN), además evaluamos la asociación de cada prueba con el grado de diferenciación histológica e infiltración perineural. Resultados: De 112 pacientes solo 80 fueron evaluables. En 46(57.5%) pacientes se confirmó cáncer prostático por estudio histológico de los cuales 38(82.7%) presentaron EDR anormal y APE>4ng/ml. De 62 pacientes con EDR anormal 40(64.5%) presentaron cáncer. El APE >10 ng/ml se detecto en 59 pacientes y 42(71.27%) de ellos tuvieron cáncer. Para un EDR anormal y APE >4ng/ml, la sensibilidad fue de 0.95, la especificidad de 0.65, el VPP de 0.76 y el VPN de 0.73. Ambas pruebas positivas se asociaron a pobre grado de diferenciación histológica. Conclusión: En la población estudiada el EDR anormal y el APE > 4 ng/ml son eficaces en la detección de cáncer de próstata. (Rev Med Hered 2002; 13:125-130 ).

Objective: To assess the efficacy of the Rectal Digital Test (RDT) and the Prostate Specific Antigen (PSA) in the detection of prostate cancer. Material and methods: It has been made a retrospective study at the Hospital Nacional Cayetano Heredia (HNCH) for the period 1977 - 1999. Clinical records of the patients that went to the Urology Service presenting prostatic symptomatology and that fulfill the inclusion criteria were revised. The efficacy of the diagnosis trials was assessed with the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). There was assessed the association to any trial with the histologic differentiation level and the perineural infiltration. Results: From 112 patients only 80 could be evaluated, 46 (57.5%) patients confirmed prostate cancer by histologic study and 38(82.7%) of them presented abnormal RDT and PSA > 4 ng/ml. From 62 patients with abnormal RDT 40 (64.5%) of them presented cancer. The PSA >10 ng/ml was detected in 59 patients and 42 (71.27%) of them suffered from cancer. For an abnormal RDT and a PSA >4 ng/ml, the sensitivity was 0.95, the specificity 0.65, the PPV 0.76 and the NPV 0.73. Both positive trials were associated with a poor level of histologic differentiation. Conclusion: In the population studied the abnormal RDT and the PSA> 4 ng/ml are efficacy to detect prostate cancer. ( Rev Med Hered 2002; 13: 125-130 ).

Estudio Piloto sobre actitudes preventivas para cáncer de mama en Mujeres de Sullana

Objetivo: Conocer las conductas preventivas para el cáncer de mama en mujeres mayores de 20 años en la Ciudad de Sullana mediante técnicas de auto examen de mama y mamografias. Pacientes y Metodos: Se encuestaron 100 mujeres mayores de 20 años en Sullana mediante ramdomizacion de tres grupos socioeconómicos a través de una encuesta y los resultados se analizaron en Epi-Info mediante bioestadística básica descriptiva. Resultados: La mediana de la edad fue de 30-34 años, 58% tiene entre 2-5 hijos, 6% son nuliparas, el 16% de mujeres mayores de 40 años alguna vez tuvo una mamografia y solo el 7% de estas mujeres se realizan una mamografía anual. El 57% nunca se realizó un autoexamen de mama, sin embargo el 56% refiere conocer la utilidad del autoexamen de mama, 43% conocen la técnica pero solo un 8% lo practican correctamente. Conclusiones: Mas de la mitad de la población encuestada nunca se realizo un autoexamen de mama, y del 56% de mujeres que afirman conocer la utilidad de este examen solo el 8% lo realiza correctamente, lo que nos indica una desinformación para detección temprana de cáncer de mama, además solo un 7% se realiza una mamografía anual probablemente por desconocimiento de la utilidad, por el costo o por que en Sullana no hay mamógrafo a pesar de tener 56500 mujeres en edad fértil, creemos que urgen campañas de información sobre el tema además de ofertar mamografías a esta población. (Rev Med Hered 2002; 13:131-134 ).

Objectives: To know the preventive behavior for breast cancer through breast autoexam and mammograms in women older than 20 years in Sullana - Piura. Patients and Methods: We gathered 100 women older than 20 years through a writed interview, we randomized three groups according to the socioeconomic level, the data was analyzed by Epi-Info program. Results: The median age was between 30-34 years, 58% of women have 2-5 children, 6% are nuliparous, just 16% of women older than 40 years had sometime a mammogram, and 7% have annual mammogram. 57% never have done a breast auto exam, 56% know the utility of autoexam, 43% know the technique but only 8% practice the auto exam with the adequate frequency. Discussion: More than a half of this population never have done an autoexam, and in spite of 56% know the utility of the breast autoexam just 8% did it, this is probably due to the lack of information and what is the real impact of the breast cancer; on the other hand just 7% of women older than 40 years have an annual mammogram, it results because of the lack of mammography in Sullana, this city has 56500 women in reproductive age, so we conclude that this population need more informative campaigns and to offer mammograms to this women. (Rev Med Hered 2002; 13:131-134 ).

Mamografía y Ecografía en la evaluación de las lesiones no palpables de la mama y su correlación anatomo-patológica

Objetivo: Evaluar las características mamográficas y ecográficas de las lesiones no palpables de la mama (LNP) y establecer su correlación anátomo-patológica. Material y Métodos: Estudio descriptivo retrospectivo realizado en el Instituto de Enfermedades Neoplásicas, donde se incluyeron pacientes con LNP detectadas por mamografía y que cumplieron con los criterios de inclusión, entre el 1 de Marzo de 1997 y 28 de Febrero de 1999.Resultados: Se estudiaron 104 pacientes con LNP. El 22.1% de las LNP fueron neoplasias malignas. 53 daban efecto de masa a la mamografía : forma oval 18 benigno (B), 1 maligno (M) (p<0.05), distorsión arquitectura 1 B, 8 M (p<0.05), márgenes espiculados 1 B, 10 M (p<0.05), 51 fueron microcalcificaciones (MC) aisladas, 3 fueron masas asociadas a MC, 48 que daban efecto de masa fueron evaluadas por ecografia : bordes bien definidos 20 B, 1 M (p<0.05), espiculados 0 B, 6 M (p<0.05), ecos heterogéneos 4 B, 8 M (p<0.05), ecos homogéneos hipoecogénicos 30 B, 2 M (p<0,05).Conclusiones: En las lesiones que daban efecto de masa por mamografía la forma oval y márgenes circunscritos se asociaron a benignidad, la distorsión de la arquitectura y los bordes espiculados a malignidad. En las lesiones evaluadas por ecografía los bordes bien definidos y ecos internos homogéneos hipoecogénicos fueron benignos y los bordes espiculados y ecos heterogéneos malignos. ( Rev Med Hered 2002; 13: 135-139)

Objective: To evaluate the mammographic and ultrasonographic characteristics of non palpable lesions of the breast (NPL) and to establish their anatomical-pathological correlation. Material and Methods: Descriptive study retrospective type carried out on the Instituto de Enfermedades Neoplásicas where patients with NPL detected by mammography and meet all inclusion criteria were included among March 1, 1997 and February 28, 1999. Results: 104 patients were studied with NPL. 22.1% of the NPL were breast cancer. 53 gave mass effect in mammography: oval form 18 benign (B), 1 malignant (M) (p <0.05), distortion architecture 1 B, 8 M (p <0.05), speculed margins 1 B, 10 M (p <0.05), 51 were isolated microcalcifications (MC), 3 masses associated to MC, 48 that gave mass effect were evaluated by ultrasonography : defined border 20 B, 1 M (p <0.05), spiculed 0 B, 6 M (p <0.05), heterogeneous echoes 4 B, 8 M (p <0.05), homogeneous hypoechogenic echoes 30 B, 2 M (p <0.05). Conclusions: In the lesions that gave mass effect on mammography the oval form and bounded margins were benign, the distortion of the architecture and the spiculed borders were associated with malignancy. In the lesions evaluated by ultrasonography the defined borders and internal homogeneous hypoecoghenic echoes were benign and the spiculed borders and heterogeneous echoes were malignant. ( Rev Med Hered 2002; 13:135-139 )

Comparación de las densidades parasitarias en gota gruesa de sangre venosa versus digitopunción en el diagnóstico de Malaria Vivax

Objetivo: Comparar las densidades parasitarias y resultados de la gota gruesa obtenidos por punción venosa versus los obtenidos por digitopunción en malaria por Plasmodium. vivax. Material y Métodos: Estudio transversal analítico. Se incluyó a los pacientes con sintomatología sugerente de malaria que acudieron a atenderse al Hospital San Martín de Pangoa (Junín), zona endémica para malaria por P. Vivax, entre Octubre y Diciembre de 1999. A cada paciente se le realizó dos gotas gruesas, una obtenida por punción venosa y la otra por digitopunción. Resultados: Se incluyó a 73 pacientes: 40 tuvieron malaria por P. vivax diagnosticada por examen de gota gruesa positiva tanto a partir de venopunción como de digitopunción, 1 caso fue diagnosticado sólo por examen obtenido de venopunción (densidad parasitaria: 79 parásitos/ul) y ninguno diagnosticado sólo por examen de digitopunción. Se obtuvo un índice de concordancia Kappa=0.94. No hubo diferencia significativa en la media de las densidades parasitarias obtenidas por ambos métodos (5750 vs 5577 parásitos/ul respectivamente). Conclusiones: No se encontró diferencia estadísticamente significativa entre ambos procedimientos de obtención de muestra en cuanto a densidad parasitaria ni rendimiento diagnóstico. (Rev Med Hered 2002; 13:140-143)

Objective: To compare parasite density and results obtained in the thick blood film drawed from venipuncture versus finger prick in vivax malaria. Material and methods: This is an analytic cross-sectional study. We included all patients who sought medical attention in the San Martin Pangoa Hospital (Junin) between October and December 1998 because of signs and symptoms suggestive of malaria,. Every patient had two thick blood films : one from venipuncture and other from finger prick. Results: Were included 73 patients: 40 were positive for malaria plamodium. vivax diagnosed by both methods, 1 was positive only by venipuncture ( parasite density 79 parasites/ul ), and none was diagnosed only by finger prick. We had a Kappa concordance index of 0.94. There was not significant difference in the mean parasite density (5750 vs 5577 parasite/ul, respectively) Conclusion: We could not find statistically significant difference in parasite density and diagnostic performance between the two procedures. ( Rev Med Hered 2002; 13:140-143)

Tratamiento de leishmaniasis cutánea andina con ketoconazol en dos zonas de alta incidencia del Departamento de Amazonas: reporte de casos

To report the use of Ketoconazole as alternative treatment for Andean Cutaneous Leishmaniasis (ACL) in two high incidence zones in Amazonas Department. Methods: It was considered patients with confirmed diagnosis of ACL whom there were difficulties for the administration of Pentavalent Antimonials. It was not considered patients below 2 years old, pregnant or nursing woman and patients with wounds bigger than 5 cm. diameter. Patients above 12 years old received Ketoconazole 600 mg. daily for 28 days; patients below 12 years old received only 200 mg. It was made clinical follow-up weekly during the treatment. There were treated 2 patients above and 2 patients below 12 years old. The two younger and one of the older had not been received any previous medical treatment, the other one had been received two previous courses of Glucantime®. The treatment was successful in the 4 cases. It was made clinical follow-up for 3 months in the younger patients and it was observed complete healing and absence of new lesions. Ketoconazole, 600 mg. daily for 28 days for below 12 years old patients and 200 mg. daily for above 12 years old patients could be considered an alternative treatment for ACL in Inguilpata and Yerbabuena Districts; in patients with or without previous Pentavalent Antimonials Treatments. (Rev Med Hered 2002; 13: 144-147)

Efectos adversos de consecuencia fatal por tratamiento con fármacos antituberculosos

We report the case of a patient with several adverse effects, of fatal consequence, associated with drugs used in the treatment for Tuberculosis. Patient was hospitalized at the Hospital Nacional Arzobispo Loayza of Lima, Peru, since May until July 2001. We identified the presence of several adverse effects associated with antituberculosis drugs (dermatitis, nausea, vomit, interstitial nephritis, hepatitis for drug and thrombocytopenia, associated with Intracraneal hemorrhage, of fatal consequence). This study reports a case very infrequent in the world (including Peru), in relation with the presence of several adverse effects of antituberculosis drugs, in the same patient, who died because of these effects. We want to inform the potential risks associated with antituberculosis drugs (of great use in Peru for the high prevalence of Tuberculosis), that must have a regimen and adequate control to avoid severe consequences. (Rev Med Hered 2002; 13: 148-152).

New and older quinolones

Quinolones are a family of antibiotics of great importance in the management of several community and nosocomial diseases. Therefore, it is important to know the qualities of the old and new quinolones. Quinolones, as anti-infectious agents, are effective and safe and few times occurs adverse events. After 1962, when the first quinolon, nalidix acid, appeared, new generations of quinolones (fourth generation) have appeared in the market. However, we should know strictly its indications, most infectious diseases are the agents of elections, but in another cases, are drugs of second line. The objective of this review is to know better all quinolones in order to avoid the appearance of resistance due to its mal practice. In this review, we present pharmakocinetic aspects, currently indications of the fluorquinolones, the importance of new quinolones, the mechanisms of resistance, its contraindications and adverse events. (Rev Med Hered 2002; 13:153-160).