There is much expectation on the introduction of prophylactic vaccines against human papilloma virus specifically against 16 and 18 oncogenic type, as theoretically would permit to prevent approximatelly 70% of uterine cervical cancer in the world. The vaccine has been approved in some countries and there is the intention to introduce it in the national programs of immunizations. For example, some states of the United States of North America are considering vaccination obligatory in girls in school age. The objective of this chapter is to determine the effect vaccination would have in uterine cervical cancer screening. For such we need to review the natural history of HPV infection by cervical neoplasia.

Prevention of cervical cancer has evolved very rapidly in recent years; now has a better understanding of the natural history of infection with oncogenic human papilloma virus, is known more about the genesis of pre-cancerous lesions and subsequent progression to invasive cancer (1). As a result of this better understanding of the natural history of disease, it has also seen an evolution in the recommendations for detection (2) and management of precursor lesions of cervical cancer (3). In this issue we are presenting the first case for discussion, which must be followed by other cases shared by the author, or cases received from colleagues readers of this magazine.

This section of the magazine aims to review protocols for management of patients with positive screening or diagnosis of cervical lesions. In recent years there have been published new recommendations, and others are in the process of publication, which may cause some confusion among the medical community. In 2013 the World Health Organization released its new guidelines for the prevention of cervical cancer and it considers three options for primary screening: Pap, visual inspection with acetic acid (VIA), and the test for the detection of the human papillomavirus (HPV).

OBJECTIVE. To evaluate distribution of intraepithelial squamous lesions (ISL) detected by citology and to determine priority age groups in cervical cancer detection. DESIGN. Retrospective descriptive study. METHODS. Study of 61846 cervical citologies obtained at DISUR II eripheric centers between january 1994 and december 1996. Statistical analysis was by frequencies, percentages and statistical validation by Epi-In/b. RESULTS. Sixty-five percent of Papanicolaou smears were obtained from women below 30 year-old and 35% from older women. Women below 30 bad low grade ISL (ISL-LG) in 0,3% and high grade ISL (ISL-HG) in 0,07%; older women bad 0,24% ISL-LG and 0,38% ISL-HG. CONCLUSION. If we consider that the woman with ISL-HG has a higher risk toprogress to cervical cancer and that ISL-HG increases after age 30, we recommend to start studying cervical citology at this age.

We report the case of a patient who underwent 15 years ago to removal of right ovarian tumor at another institution, admitted to the gynecology by a tumor apparently dependent gynecological sphere. Exploratory laparotomy showed a tumor in the bladder and other retroperitoneal surface attached to the vena cava. The pathological study reported that both were metastatic ovarian TCS-TA. The pathology Iáminas surgery performed 15 years earlier was revised, confirming that corresponded to the same entity.

OBJECTIVES: To determine if the Pap smear decreases the risk of developing invasive cervical cancer and cytological features history of patients with invasive cervical cancer. DESIGN: Descriptive, transversal. LOCATION: Department of Gynecology and Obstetrics of Mary Help Support Hospital. MATERIALS AND METHODS: cytological screening of 59 patients with histologically confirmed invasive cervical carcinoma and 155 with squamous intraepithelial lesion high grade (LEI-AG), seen between January 1997 and September 1998. RESULTS: Of the patients invasive cancer, 53.4% had never had cytology and 65.5% of patients had no PAP or the last study was conducted for more than five years; 31% of patients had gynecologic evaluation and negative PAP in the last three years. Of patients with squamous intraepithelial lesions of high grade (LEI-AG), 35.2% had never done a PAP or had had for more than five y...

OBJECTIVES: To determine if the Pap smear decreases the risk of developing invasive cervical cancer and cytological features history of patients with invasive cervical cancer. DESIGN: Descriptive, transversal. LOCATION: Department of Gynecology and Obstetrics of Mary Help Support Hospital. MATERIALS AND METHODS: cytological screening of 59 patients with histologically confirmed invasive cervical carcinoma and 155 with squamous intraepithelial lesion high grade (LEI-AG), seen between January 1997 and September 1998. RESULTS: Of the patients invasive cancer, 53.4% had never had cytology and 65.5% of patients had no PAP or the last study was conducted for more than five years; 31% of patients had gynecologic evaluation and negative PAP in the last three years. Of patients with squamous intraepithelial lesions of high grade (LEI-AG), 35.2% had never done a PAP or had had for more than five y...

OBJECTIVE. To evaluate distribution of intraepithelial squamous lesions (ISL) detected by citology and to determine priority age groups in cervical cancer detection. DESIGN. Retrospective descriptive study. METHODS. Study of 61846 cervical citologies obtained at DISUR II eripheric centers between january 1994 and december 1996. Statistical analysis was by frequencies, percentages and statistical validation by Epi-In/b. RESULTS. Sixty-five percent of Papanicolaou smears were obtained from women below 30 year-old and 35% from older women. Women below 30 bad low grade ISL (ISL-LG) in 0,3% and high grade ISL (ISL-HG) in 0,07%; older women bad 0,24% ISL-LG and 0,38% ISL-HG. CONCLUSION. If we consider that the woman with ISL-HG has a higher risk toprogress to cervical cancer and that ISL-HG increases after age 30, we recommend to start studying cervical citology at this age.

We report the case of a patient who underwent 15 years ago to removal of right ovarian tumor at another institution, admitted to the gynecology by a tumor apparently dependent gynecological sphere. Exploratory laparotomy showed a tumor in the bladder and other retroperitoneal surface attached to the vena cava. The pathological study reported that both were metastatic ovarian TCS-TA. The pathology Iáminas surgery performed 15 years earlier was revised, confirming that corresponded to the same entity.

There is much expectation on the introduction of prophylactic vaccines against human papilloma virus specifically against 16 and 18 oncogenic type, as theoretically would permit to prevent approximatelly 70% of uterine cervical cancer in the world. The vaccine has been approved in some countries and there is the intention to introduce it in the national programs of immunizations. For example, some states of the United States of North America are considering vaccination obligatory in girls in school age. The objective of this chapter is to determine the effect vaccination would have in uterine cervical cancer screening. For such we need to review the natural history of HPV infection by cervical neoplasia.

El presente trabajo busca analizar cuáles son los determinantes cualitativos y cuantitativos del acceso al servicio de gas natural para las familias en las regiones de Lima, Callao e Ica para luego identificar cuáles son los factores que inciden en la demanda de este servicio. Este trabajo es relevante para el contexto peruano en el que se evidencia el poco uso de energía más económica y menos contaminante a pesar de contar con programas que promueven su uso como es el caso de Bono Gas, lo cual no se ve en otros países de Latinoamérica como es el caso de Colombia. El método a utilizar para verificar el análisis es el modelo discreto continuo de Heckman que consta de dos etapas: un modelo Logit y una regresión MCO. Se espera que algunas de las variables cualitativas estén relacionadas a las características del hogar que se justifican con la literatura sobre acceso a los servic...

El presente trabajo busca analizar cuáles son los determinantes cualitativos y cuantitativos del acceso al servicio de gas natural para las familias en las regiones de Lima, Callao e Ica para luego identificar cuáles son los factores que inciden en la demanda de este servicio. Este trabajo es relevante para el contexto peruano en el que se evidencia el poco uso de energía más económica y menos contaminante a pesar de contar con programas que promueven su uso como es el caso de Bono Gas, lo cual no se ve en otros países de Latinoamérica como es el caso de Colombia. El método a utilizar para verificar el análisis es el modelo discreto continuo de Heckman que consta de dos etapas: un modelo Logit y una regresión MCO. Se espera que algunas de las variables cualitativas estén relacionadas a las características del hogar que se justifican con la literatura sobre acceso a los servic...

Objectives: To analyze adequate Papanicolaou obtention feasibility during menstruation by thoroughly and softly cleaning the uterine cervix from blood before securing the sample. Design: Correlation prospective study of repeated measurements. Participants: Women in reproductive age. Methods: Three hundred and eighty nine women attending four Lima South region hospitals participated in the study; analysis was done in 208 of them after obtaining a pair of Papanicolaou smears from each woman corresponding to their menstrual and non menstrual periods. The smear taken during menstruation was collected after careful and soft cleaning of the uterine cervix and waiting for absence of menstrual pulse through the cervical os. Two pathologists studied the smears separately. Main outcome measures: Adequacy of Papanicolaou samples obtained during menstruation. Results: Smear samples from menstrual an...