The early diagnosis of cervical cancer remains a gynecological problem that requires an immediate solution; because we continue to see with surprise that the highest rate of cancer mortality in women occupies cervical cancer; This is undoubtedly due to the ill treatment reach an advanced level of disease; recognizing that late diagnosis is still made, however great concern and interest shown by medical researchers to overcome techniques to achieve early diagnosis and if we add to all this propaganda organized by the state, we see that there is very little that has been obtained in relation to the great effort made. This is the reason I am going to present for the consideration of all of you. Progress on semiotic technique has been achieved so far to get to early diagnosis and personal contribution in more than 15 years of observation.

I have considered of great interest to present the first case of vesico - uterine fistula ( L vu ), followed by cesarean section , observed in the Hospital Loayza , Pavilion 5, Room 2nd descriptions in the literature are not very numerous. Neugeveaur in 1888 (quoted by Knipe 1908 ) (3 ) , in a review of cases of urogenital fistulas, found a case that opened near the internal os of the cervix . Mac Kenzie (1921 ) (quoted by Myron Nourse ) (7 ) observed a case. Kirchner ( 1933 ) cit. by Magri ( 3) published a new observation . Laffont and Ezes ( 5) ( 1946 ) reviewed the subject in a publication that they titled , " utero- vesical fistula with a single direction and rules " , consecutive cesarean section . Mazingarbe and Musset (quoted by Moonen ) (4 ) makes references to two new observations followed caesarean section. Bond and Rogers ( 1) ( 1952 ) , work in a well-documented report a case...

In recent years Gynecological Surgery Vaginal, has taken a leading position in many schools, compared with surgery through the abdomen. These developments are evident for vaginal route celiotómica as indications, contra-indications and techniques to follow for the treatment of conditions of the external organs, vagina and neck, it is common to be well known.

Total hysterectomy with resection of 1/3 of the vagina and parametrium, with or without bilateral oophorectomy, is recommended for State "0" of Epidermoid Carcinoma of the Cervix. In State I the therapeutic measure depends on the sensitization response (SR) which would indicate whether surgery or radiation should be use. lf surgery is indicated, radical total hysterectomy with node dissection should be performed. Radiation is the method of election for State II, except in thouse cases in which there is a poor "radiation response" (RR). Radical hysterectomy with node dissection should be the treatment in the surgical cases of this group. We have no doubt that the cytological evaluation by means of the "SR" and "RR" responses is a great help in the selection of the treatment. In State III and IV, radiation is the method of election. If recurrence occurs after radiation therapy pelvic exent...

Editorial

Teaching of obstetrics and gynecology at the graduate level.

Appointed by the Society of Obstetrics and Gynecology in Lima, we concur to the aforementioned events, Drs. Mariano Bedoya (Secretary General of the Society) and Dr. Alberto Santos former president of the same.

Genuine hyperplasia, macroscopically be confused with cancer; but it is distinguished because the latter presents necrosis and friability. Adenomatous hyperplasia can be mistaken for cancer; in the opinion of several authors (Gundberg, Kaplan), atypical changes are related to prolonged estrogen stimulation. Novack acknowledge the existence of some correlation between post-menopausal hyperplasia and adenocarcinoma. Wilson and Beecham and Carrington expressed the adenomatous hyperplasia exhibits sufficient evidence to be considered as precancerous lesions or carcinoma in-situ. Prolonged estrogen stimulation in women genetically predisposed to cancer, can initiate carcinogenesis. You may metaplasia and endometrial polyps can be considered as pre-malignant lesions in the elderly woman.

The experience allows us to advise the most appropriate surgical procedure in case of IOE; to this end we propose the following classification: 1. IOE accompanied by urethrocele or cyst-urethrocele, the most frequent cases. 2. I.O.E. as a result of surgical or obstetric trauma, without uretrocele nor cysto-urethrocele. 3. I.O.E. accompanied by vaginal prolapse. 4. I.O.E. accompanied by uterine tumor pathology or annexes. 5. I.O.E. in patients who previously he underwent total hysterectomy or subtotal. 6. I.O.E. in nulliparous patients. In Group No. 1, I.O.E. mild, the behavior is the simple folding pubo-vesico-cervical fascia excellent results. If I.O.E. severe, we prefer the combined processes (Techniques Goebell - Stoeckel or Marshall-Marchetti). In the No. 2 Group, we mobilize the urethra vaginal and cure ends with combined intervention. In Group No. 3 treat prolapse with fascia plica...

Our behavior we adopt the criterion of "operability" of Haagansen and Stout and continue practicing Radical Mastectomy associating postoperative radiotherapy, and for the moment we do not support expanded operations: a) the supraclavicular for consideration at the group of inoperable b) of the internal mammary chain, because we expect to be sanctioned by time; rather we advise exploratory behavior, in order to establish an accurate forecast. We recommended in elderly with high surgical risk and simple mastectomy and ulcerated tumors as a palliative measure. We remove the only recurrences and ordered the radiotherapy treatment. The oophorectomy in young, we do not do routine; remissions observed when practiced in recurrences and metastases. The other procedures await the sanction of time.

To address the issue of surgical treatment of genital prolapse is imperative to refer to the values of the different anatomical structures that focus on the basic principle that surgical techniques are based to bring the prolapsed organs to their normal position.

We have studied the oxytocic effect cervical ripening and enhancing oxytocin to 17 -Beto Estradiol applied in amniotic cavity in 10 pregnant women aged 38 or 40 weeks gestation action. Obtaining increased uterine activity due to an increase in the intensity and frequency of the contractions, cervical ripening in 50% of cases and the large increase in uterine activity when small doses of oxytocin administered, thus demonstrating the enhancing effect of this hormone oxytocin.

Dissemination and knowledge of vulvar cancer is paramount. Although it is a rare and poorly understood condition, his interest is in making a timely diagnosis, followed by an enlarged super extended as surgery or cancer surgery is conceived at present. This surgery offers huge possibilities of healing as the primary lesion remains stationary, although, it is true, that gives metastases with great frequency, as indicated Taussig observing up to 66% of them in the regional lymph not spread to distant organs, comments they are confirmed by Way and other researchers.

Appointed by the Society of Obstetrics and Gynecology in Lima, we concur to the aforementioned events, Drs. Mariano Bedoya (Secretary General of the Society) and Dr. Alberto Santos former president of the same.

We have studied the oxytocic effect cervical ripening and enhancing oxytocin to 17 -Beto Estradiol applied in amniotic cavity in 10 pregnant women aged 38 or 40 weeks gestation action. Obtaining increased uterine activity due to an increase in the intensity and frequency of the contractions, cervical ripening in 50% of cases and the large increase in uterine activity when small doses of oxytocin administered, thus demonstrating the enhancing effect of this hormone oxytocin.

Dissemination and knowledge of vulvar cancer is paramount. Although it is a rare and poorly understood condition, his interest is in making a timely diagnosis, followed by an enlarged super extended as surgery or cancer surgery is conceived at present. This surgery offers huge possibilities of healing as the primary lesion remains stationary, although, it is true, that gives metastases with great frequency, as indicated Taussig observing up to 66% of them in the regional lymph not spread to distant organs, comments they are confirmed by Way and other researchers.

Our behavior we adopt the criterion of "operability" of Haagansen and Stout and continue practicing Radical Mastectomy associating postoperative radiotherapy, and for the moment we do not support expanded operations: a) the supraclavicular for consideration at the group of inoperable b) of the internal mammary chain, because we expect to be sanctioned by time; rather we advise exploratory behavior, in order to establish an accurate forecast. We recommended in elderly with high surgical risk and simple mastectomy and ulcerated tumors as a palliative measure. We remove the only recurrences and ordered the radiotherapy treatment. The oophorectomy in young, we do not do routine; remissions observed when practiced in recurrences and metastases. The other procedures await the sanction of time.

Total hysterectomy with resection of 1/3 of the vagina and parametrium, with or without bilateral oophorectomy, is recommended for State "0" of Epidermoid Carcinoma of the Cervix. In State I the therapeutic measure depends on the sensitization response (SR) which would indicate whether surgery or radiation should be use. lf surgery is indicated, radical total hysterectomy with node dissection should be performed. Radiation is the method of election for State II, except in thouse cases in which there is a poor "radiation response" (RR). Radical hysterectomy with node dissection should be the treatment in the surgical cases of this group. We have no doubt that the cytological evaluation by means of the "SR" and "RR" responses is a great help in the selection of the treatment. In State III and IV, radiation is the method of election. If recurrence occurs after radiation therapy pelvic exent...

In recent years Gynecological Surgery Vaginal, has taken a leading position in many schools, compared with surgery through the abdomen. These developments are evident for vaginal route celiotómica as indications, contra-indications and techniques to follow for the treatment of conditions of the external organs, vagina and neck, it is common to be well known.

To address the issue of surgical treatment of genital prolapse is imperative to refer to the values of the different anatomical structures that focus on the basic principle that surgical techniques are based to bring the prolapsed organs to their normal position.