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Objetivo: describir los resultados postoperatorios de las pacientes sometidas a histerectomía radical por cáncer de cuello uterino entre junio 2007 y junio 2017 en el Hospital de San José de Bogotá. Materiales y métodos: revisión retrospectiva de las histerectomías radicales por vía abierta realizadas por cáncer de cuello uterino en estadios de la FIGO (International Federation of Gynecology and Obstetrics) IA2 a IIA1. Se incluyeron variables de tipo clínico, anatomopatológico y complicaciones. Resultados: en total fueron 70 pacientes con promedio de edad de 45.5 años (DE 11.1). Los tipos histológicos corresponden a escamocelular (n= 59, 84.3%) y adenocarcinoma (n=11, 15.7%). El sangrado intraoperatorio promedio fue de 700 cc (rango: 50-1000, la tasa de transfusión fue 12.9% (9 pacientes). Hubo complicaciones intraoperatorias en 7 (9.9%), 5 lesiones vasculares, una lesión del ureter y otra de la serosa del sigmoide. Se detectó compromiso de bordes en siete (10%), metástasis ganglionar en 5 pacientes (8.6%) y lesión parametrial en 3 (4.3%). El tamaño tumoral fue < 2 cm en 42 pacientes (60%), invasión estromal <1/3 en 42 (62,3%) e invasión linfovascular en 18 (25.7%). En el postoperatorio una paciente desarrolló infección del sitio operatorio (1.4%), 3 presentaron disfunción vesical (4.3%) y 23 requirieron radioterapia (32.8%). Conclusiones: el estado de la cirugía radical abierta en el Hospital de San José muestra un volumen importante de histerectomía radical, comparable con otras instituciones, con una tasa de complicaciones similar.

Objective: To describe postoperative outcomes after radical hysterectomy in cervical cancer patients, between June 2007 and June 2017 at Hospital de San José in Bogotá. Materials and Methods: a retrospective review of radical abdominal hysterectomies for treating FIGO (International Federation of Gynecology and Obstetrics) stages IA2-IIA1 cervical cancer. Variables included clinical and pathologic features, and complications. Results: A total of 70 patients with mean age 45.5 years (SD 11.1) were included. Histology confirmed squamous cell carcinoma in 84.3% (n= 59) and adenocarcinoma in 15.7% (n=11). Average estimated blood loss was 700 cc (from 50 - 1000 cc, transfusion index was 12.9%, 9 patients). Intraoperative complications presented in 7 patients (9.9%) and included vascular injury in 5 patients, ureteral injury in one patient and serosal injury to sigmoid colon in one patient. Positive surgical margins were detected in 7 patients (10%), lymph node metastases in 5 patients (8.6%) and parametrial involvement in 3 patients (4.3%). Tumor size was < 2 cm in 42 patients (60%), stromal invasion <1/3 in 42 patients (62.3%) and lymph node and vascular invasion in 18 patients (25.7%). One patient developed postoperative wound infection (1.4%), 3 presented bladder dysfunction (4.3%) and 23 required radiotherapy (32.8%). Conclusions: open radical surgery at Hospital San José includes an important volume of radical hysterectomies, comparable to that reported by other institutions with a similar complication rate.

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RESUMEN Introducción: En este artículo se presenta la utilización de la espectroscopia de impedancia eléctrica (EIE) en la caracterización del tejido columnar cervical y como herramienta de apoyo a las técnicas diagnósticas del cáncer de cuello uterino. Métodos: Se realizó un estudio de validez diagnóstica a 30 pacientes no menopáusicas que presentaron ectopia cervical durante la colposcopia. Se obtuvieron 129 espectros de impedancia eléctrica de tejido columnar, que fueron diferenciados en cuatro zonas o puntos de toma de medidas, semejantes a las zonas horarias 12, 3, 6, y 9 de un reloj análogo. Los datos experimentales obtenidos fueron ajustados al modelo de Cole-Cole, que describe la fisiología y estructura del tejido mediante parámetros eléctricos de resistividad R y S, frecuencia característica Fc y capacitancia de membrana Cm. Resultados: La comparación entre tejidos columnares sanos y con lesión en cada uno de los puntos de medida se realizó mediante pruebas no paramétricas U de Mann-Whitney, que mostraron diferencias estadísticamente significativas (p <0,05) para las medianas de R y S, con un nivel de confianza del 95%. Los valores promedio de R y S para tejido columnar sano fueron 2,0 Ω-m y 11,36 Ω-m, con desviación estándar 0,41 y 0,51 respectivamente; mientras que para los tejidos con lesiones el valor promedio R y S fueron de 4,21 Ω-m y 7,03 Ω-m, con desviación estándar 0,40 para ambas medidas. Conclusión: Se encontró que la resistividad del líquido extracelular R y la resistividad de la matriz intracelular S son las que mejor discriminan entre epitelios columnares sanos y aquellos afectados por lesiones.

ABSTRACT Introduction: Thi s pape r shows the implementation of Electrical Impedance Spectroscopy (EIS) in the characterization of the cervical columnar tissue and as a supporting tool to the diagnostic techniques of cervical cáncer Methods: A diagnostic validity study was performed on 30 non-menopausal patients who presented cervical ectopy during colposcopy. A total of 129 electric impedance spectra of columnar tissue was obtained, which were differentiated into four measurement zones or points similar to time zones 12, 3, 6, and 9 of an analog clock. The experimental data obtained were adjusted to the Cole-Cole model which describes the physiology and structure of the tissue through electrical resistivity parameters R and S, characteristic frequency Fc and membrane capacitance Mc. Results: The comparison between healthy and damaged columnar tissue at each of the measurement points was performed using non-parametric Mann-Whitney U tests which showed statistically significant differences (p <0.05) for the R and S medians with a 95% confidence level. The average values of R and S for healthy columnar tissue were 2.0 Ω-m and 11.36 Ω-m, with 0.41 and 0.51 standard deviation respectively, whereas for a damaged tissue the average value of R and S were 4.21 Ω-m and 7.03 Ω-m, with 0.40 standard deviation for both measurements. Conclusions: It was found that the resistivity of the extracellular liquid R, and the resistivity of the intracellular matrix S, are the parameters that better discriminate between healthy columnar epithelia and those affected by lesions.

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Unconjugated hyperbilirubinemia resulting from therapy with atazanavir is physiologically related to hyperbilirubinemia in Gilbert's syndrome (GS). In patients with GS, changes in diet have a significant impact on bilirubinemia. Our aim was to investigate whether changes in diet affect the level of serum bilirubin in patients receiving atazanavir. Thirty patients on stable therapy with ritonavir-boosted atazanavir without evidence of GS were enrolled. Hemolysis and chronic hepatitis were excluded. After a baseline period of normal intake of calories, the patients were randomized to follow a 24-h 400-calorie diet (fasting), then a 48-h period of normal calorie intake and, afterward, a 24-h period of a high-calorie diet, or the same interventions in inverse order. Serum bilirubin concentrations were measured before and after each intervention. A high adherence to the recommended diet was observed. The mean unconjugated bilirubin concentration before the high-calorie diet was 2.79±1.53 mg/dl and after such intervention it was 2.70±1.40 mg/dl. The mean difference between preintervention and postintervention was -0.08±0.69 mg/dl (p=NS). The mean unconjugated bilirubin concentration before the fasting diet was 2.31±1.23 mg/dl and it was 3.84±1.90 mg/dl after. The mean difference between prefasting and postfasting was 1.53±1.17 mg/dl (p=0.001). According to these results, short periods of fasting seem to increase the unconjugated bilirubin concentration in patients on atazanavir. A high-calorie diet did not have any impact in bilirubin probably because most patients follow similar diets in their everyday life.

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