S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400001 Anormalidades menstruales, transtornos endocrinos: Amenorrea Zúñiga Brenes Carlos Luis , 10 2005 2005 47 171 171
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400002 Un modelo de desarrollo científico en Costa Rica Jiménez Bonilla Rafael , 10 2005 2005 47 172 172
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400003 Hemoglobinas anormales Sáenz-Renauld German F , 10 2005 2005 47 173 179

Es notorio que en Costa Rica la frecuencia de las variantes más comunes de la hemoglobina (Hb) (S Y C) puede ser trazada desde África. Estas hemoglobinas son dos marcadores genéticos que han mantenido un equilibrado polimorfismo contra la presión selectiva de la malaria, en los países de origen o ancestrales. En la población caucásica son muy raras las mutantes estructurales de la Hb y se considera que nuestros indígenas no presentan ninguna alteración en elloci de la Hb. Un breve repaso antropológico, clínico, diagnóstico, genético y epidemiológico deja claro el verdadero problema de salud pública de estas enfermedades hereditarias de la hemoglobina, con especial énfasis en la drepanocitosis. Tangencialmente se destaca el problema de la deficiencia de la deshidrogenasa de la glucosa-6-fosfato en la etnia negra/negroide del país.

The frequecy of the commonest costarican Hgb varieties can the tracked to Africa. Hbg S and C, are genetic markers, that maintain a balanced polymorphism against malaria at the countries of origen. Among the caucasian population structural mutations of Hgb are unusual and it is felt that our indians exhibited no alteration at their Hgb loci. The real public health problem of hederitary Hgb diseases, specially drepanocytosis, can be seen through a brief anthropological, clinical, diagnostic, genetic, and epidemiological review. The problem of G6PD deficiency in blacks and negroids is alluded to.

 Hemopoyesis genes de globina hemoglobinas anormales anemia hereditaria síndromes drepanocíticos haplotipos del gene drepanocítico Hemopoiesis globin genes abnormal hemoglobines malaria hereditary animia sickle cell syndromes sickle cell gene haplotipes Livinsgtone FB Winter WP Anthropological aspects of the distribution of the human hemoglobin variant Anthropological aspects of the distribution of the human hemoglobin variant 1986 11 New York CRC Press Cabannes RJR Fabritius H Sangare A Kple-Faget P Winter WP Hemoglobin variants: distribution in West Aftica Hemoglobin variants: distribution in West Aftica 1986 11 New York CRC Press Colombo B Martínez G Hemoglobinopathies; part 2 Tropical America Clin. Haematol 1981 10 Sáenz GF Rodríguez W Chaves M Variantes estructurales de la hemoglobina en ibero américa Rev. Biol. Trop 1993 41 Sáenz GE Winter W.P Hemoglobinopathies in Central America Hemoglobinopathies in Central America 1986 11 New York CRC press Tratamiento de las hemoglobinopatías y de los trastornos afines: Informe de un grupo científico de la OMS Tratamiento de las hemoglobinopatías y de los trastornos afines: Informe de un grupo científico de la OMS 1972 Community control of hereditary anaemias: memorandum from a WHO meeting WHO Bull 1983 61 Report of the second annual meeting of the WHO Working Group on the community control of hereditary anaemias: Archbishop Makarios thalassaemia Centre, Cyprus 29-31 november Report of the second annual meeting of the WHO Working Group on the community control of hereditary anaemias: Archbishop Makarios thalassaemia Centre, Cyprus 29-31 november 1983 Barrantes R Diversidad Genética y Mezcla Racial en los amerindios de Costa Rica y Panamá Rev. Biol. Trop 1993 41 Sáenz R Jiménez M Chaves M Quintana E Sáenz GE Estudio sobre la coexistencia de Hemoglobina S y de la deficiencia de la Glucosa-6-PD deshidrogenasa en población de raza negra (Costa Rica) Rev. Cost. Ciencias. Med 1986 7 Motulsky AG Metabolic polimorfims and role of infectius diseases in human population Hum. Biol 1960 32 Weatherall D.J Thalassaemia and malaria, revisseted Aun. Trop. Med. Parasitol 1997 91 Gibbs WN Warde J Serjeant GR Glucose-6-phosphate dehydrogenase deficiency and homozigous sickle cell disease in Jamaica Br. J. Haematol 1980 45 Bienzle U Sodeinde U Effong EE Luzzato L G6PD and sick le cell anemia: frecuency and features of the association in Aftican community Blood 1975 46 Konotey-Ahulu FID Glucose-6-phophate dehydrogenase deficiency and homozigous sickle cell anemia N. Engl. J. Med 1972 287 Aguilar E Piedra R Un caso de drepanocitemia en una mujer costarricense Rev. Med. Costa Rica 1945 139 Elizondo J Anemia de células falciformes: Reporte de un caso de priapismo por drepanocitosis (Costa Rica) Anemia de células falciformes: Reporte de un caso de priapismo por drepanocitosis (Costa Rica) Congreso Centroamericano de Medicina 1961 Biker IN Elizondo J Zomer M Hemoglobinopatías Acta Med. Cost 1965 8 Elizondo J Solano L Hemoglobinopatía S.C Acta Med. Cost 1965 8 Sáenz GE Ramírez V Chaves M Enfermedad por Hbs S y C y patología ocular Acta Med. Cost 1982 3 Solano L Cabezas M Elizondo L Estudio sobre drepanocitosis y hemoglobina "S" en Santa Cruz de Guanacaste Acta Med. Cost 1966 9 Solano L Mainieri E Estudio sobre drepanocitosis y hemoglobina S en Liberia, Guanacaste Acta Med. Cost 1967 10 Rivera A Sáenz GF Datos numéricos y estadísticos mínimos sobre la incidencia de hemoglobinas anormales en Costa Rica Rev. Med. Hosp. Nal. Niños 1968 2 Sáenz G.E Arroyo G Jiménez J Gutiérrez A Barrenechea M Brilla E Investigación de hemoglobinas anormales en población de raza negra costarricense Rev. Biol. Trop 1971 19 Sáenz G.E Brilla E Arroyo G Valenciano E Jiménez J Deficiencias de la deshidrogenasa de la glucosa-6-fosfato (G-6PD) Eritrocitica en Costa Rica: 1. Generalidades sobre el defecto y hallazgos en población de raza negra Rev. Med. Hosp. Nal. Niños 1971 6 Sáenz GF Alvarado MA Atrnetlla E Arroyo G Jiménez R Valenciano E Investigación de hemoglobinas anormales en población costarricense del Guanacaste Acta Med. Cost 1973 16 Sáenz GF Elizondo J Arroyo G Jiménez J Montero AG Valenciano E Diagnóstico de hemoglobinopatías y de trastornos afines: Enfoque población del problema Bol. Of. Sanit. Panam 1981 90 Sáenz G.E Elizondo J Arroyo G Valenciano E Rojas LE Jiménez J Hemoglobinopatías en 12.000 escolares costarricenses Acta Med. Cost 1980 23 Sáenz RI Sáenz GF Muñoz D Chaves M enfermedad homocigótica por Hb C: Primer reporte Nacional, 1984 Rev. Med. Hosp. Nal. Niños 19 Sáenz GF Alvarado MA Elizondo J Arroyo G Atrnetlla E Jiménez J Chemical characterization of a new haemoglobin variant: Haemaglobin J-Cubujuquí (alpha2 141 (HC3) Arg-Ser). 1977 Acta Biochim. Biophys 1977 494 Sáenz GF Alvarado MA Arroyo G Montera AG Jiménez J Hemoglobin Suresnes in a Costa Rican Woman of SpanishIndian ancestry Hemoglobin 1978 2 Sáenz GF Elizondo J Arroyo G Valenciano E Jiménez J Montera AG Hallazgo de la Hemoglobina G Philadelphia (alfa 68 (EI7) Asn-Lis) en Costa Rica: Consideraciones bioquimicogenéticas Sangre 1981 26 Rodríguez WE Jiménez J Chaves M Montera G Sáenz GF Hallazgo de la Hb I (? 16 (AI4) Lis-Glu) en Costa Rica Rev. Cost. Ciencias Med 1995 16 Elizondo J Sáenz GE Alvarado MA Ramón M Hallazgo de la hemoglobina Korle-Bu (alfa2 beta2 73 asp-asn) en Costa Rica Sangre 1976 1 Sáenz GF Elizondo J Colombo B Alvarado MA Arroyo G Atmetlla F Hallazgo de la hemoglobina E (Beta 26 glu-lis) en Costa Rica Sangre 1977 22 Sáenz GF Elizondo J Arroyo G Jiménez J Montera AG Finding of the hemoglobin New York in Costa Rica Hemoglobin 1980 4 Rodríguez WE Castillo M Chaves M Sáenz GE Gu LH Wilson JB Hemoglobin Costa Rica: The first example of a somatic cell mutation in a globin gene Human Genet 1996 97 Stuart MJ Nagel RL Sickle cell disease Lancet 2004 364 Pawliuk R Westerman KA Fabry ME Correction of sickle cell disease in transgenic mouse models by gene therapies Science 2001 294 Znaal RF Schrort AJ Pathophysiologic implications of membrane phospholipid asymmetry in blood cell Blood 1997 89 Serjeant GR Sickle cell disease: Oxford university press Sickle cell disease: Oxford university press 1985 Serjeant GR Serjeant BE Forbes M Hayes RJ Higgs DR Lehmann H Hemoglobin gene frequencies in the Jamaican population: a study in 100.000 Newboms Brit. J. Haematol 1986 65 Serjeant GR Grandison Y Lowrie Y Mason K Phyllips J Serjeant BE The development of haematological chages in homozygous sickle cell disease: a cohor study from birth to 6 years Br. J. Haematol 1981 48 Naoum PC Naoum FA Doenca das celulas falciformes Doenca das celulas falciformes 2004 Sao Paulo Savier Valverde K drepanocitosis: terapia actual Rev. Med. Hosp. Nal. Niños 2004 39 Vichinsky E New therapies in sickle cell disease Lancet 2003 360 Rodríguez WE Sáenz GF Josafovska O Nagel RL TheAfrican ports of origin of individuals of African descendent in Costa Rica: the use of? -gene cluster haplotypes TheAfrican ports of origin of individuals of African descendent in Costa Rica: the use of? -gene cluster haplotypes 1994 Rodríguez WE Sáenz GE Chaves M haplotipos de al HbS: importancia, epidemiología y antropología clínica Rev. Panam. Salud pública 1998 3 Sáenz GE Chaves M Quintana E Polimomsmo de la deshidrogenasa de la glucosa-6- fosfato "G6PD" eritrocítica en Costa Rica Sangre 1988 33 Elizondo J Sáenz GF Páez CA Ramón M García M Gutiérrez A G6PD- Puerto Limón: a new deficient varíant of glucose-6-phosphate dehidrogenasa associated with congenital nonspheracytic hemolytic anemia Human Genetics 1982 62 Sáenz GF Chaves M Barrantes A Elizondo J Montera AG Yoshida A A glucosa-6-phosphate varíant, Gd(-) Santamaría in Costa Rica Acta Haemat 1984 72
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400004 Manifestaciones clínicas del síndrome del ovario poliquístico Fernández-Morales Donald , 10 2005 2005 47 180 185

El SOP es el trastorno endocrino más frecuente en mujeres jóvenes. Desde 1976 Kahn describe la relación entre el androgenismo ovárico y la resistencia a la insulina. Bergen, en 1980, establece la asociación ovarios poliquísticos, hiperandrogenismo e hiperinsulinemia, visualizando que el SOP no solo es causa de infertilidad y anovulación, sino que tiene riesgos metabólicos asociados. La explicación del SOP fue re definida por un taller de consenso en Holanda, en 2003. Esta patología se presenta si existen al menos dos de los tres criterios siguientes: irregularidades menstruales, signos bioquímicos o clínicos de exceso de andrógenos y la presencia de la morfología de ovario poliquístico. Los ginecólogos frecuentemente diagnostican esta patología y por tal motivo se debe tener un conocimiento adecuado sobre sus manifestaciones clínicas y sus posibles riesgos en el largo plazo. La evidencia de la supuesta asociación con el cáncer de endometrio y predisposición a enfermedad coronaria es incompleta, pues la variedad de definiciones del SOP hace difícil su comparación. Dunaif refiere que la prevalencia de resistencia a la insulina es una función de la población estudiada y la sensibilidad y especificidad del método usado para medir este parámetro. También menciona que las mujeres con SOP son hiperinsulinémicas y resistentes a insulina, independientemente de la obesidad, comparadas con mujeres normales. Legro demostró que entre el 25 y el 30% de las mujeres con el SOP tienen intolerancia a la glucosa a los 30 años, y el 8% desarrollarán franca Diabetes Mellitus tipo 2, anualmente.

Polycystic ovary syndrome is the most frequent endocrine disorder. In 1976 Kahn described the relation of ovarian hyperandrogenism and insulin resistance. Bergen in 1980 established the association between polycystic ovaries, hyperandrogenism and hyperinsulinemia and described that polycystic ovary syndrome was not only a cause of infertility and anovulation, but also had an associated metabolic risk. Polycystic ovary syndrome was redefined by a 2003 Holland consensus workshop. This condition is felt to be present if there are 2 of 3 possible diagnostic criteria: menstrual irregularities, biochemical o clinical signs of androgen excess and the presence of polycystic ovary morphology. The gynecologist frequentIy makes this diagnosis and has to have an adequate knowledge of the clinical signs and the possible long term risks. The evidence of a possible association with endometrial cancer and an increased cardiovascular disease risk is incomplete because the variety of definitions of polycystic ovary syndrome makes difficult the comparison of the studies. Dunaif claims that the prevalence of insulin resistance is a function of the studied population and the sensitivity and specificity of the method used to measure this parameter. She also mentions that women with polycystic ovary syndrome are hyperinsulinemic and insulin resistant, independentIy of obesity, compared with normal women. Legro demonstrated that 25 to 30% of the women with polycystic ovary syndrome have glucose intolerance and that Diabetes Mellitus occurs in 8% each year. He says that fasting glucose concentration is not a reliable predictor of the prevalence of diabetes in comparison with the 75 grams glucose tolerance test (American Society of Diabetes). He also says that the fasting deterrnination is a berter screening method, with the same predictive value for development of micro vascular complications.

 prevalencia anovulación hiperandrogenismo ovarios poliquísticos resistencia a insulina Diabetes Mellitus tipo 2 enfermedad coronaria prevalence anovulation hyperandrogenism polycystic ovaries insulin resistance type 2 Diabetes Mellitus coronary artery disease Balen A Rajkowha M Polyeystic ovary syndrome - a systemic disorder? Best Pract Res Clin Obstet Gynecol 2003 17 Richardson M Current Perspectives in Polycystic Ovary Syndrome Am Fam Physician 2003 68 Cibula D Cifkova R Fanta M Poledne R Zlivny J Skibova J Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome Hum Reprod 2000 15 Laven J Imani B Eijkemans M Fauser B New Approach to Polycystic Ovary Syndrome and Other Forms of Anovulatory Infertility Obstet Gynecol Surv 2002 57 Legro R Diagnostic Criteria in Polycystic Ovary Syndrome Semin Reprod Med 2003 21 Lobo R Carmina E The Importance of Diagnosing the Polycystic Ovary Syndrome Ann Intern Med 2000 132 Marx T Mehta A Polycystic ovary syndrome: Pathogenesis and treatment over the short and long termo Cleve Clin J Med 2003 70 1 Zion Ben R Orvieto R Polycystic ovary syndrome: a single gene mutation or an evolving set of symptoms Curr Opin Obstet Gynecol 2000 12 The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Fertil Steril 2004 81 Azziz R Diagnostic criteria for polycystic ovary syndrome: A reap praisal Fertil Steril 2005 83 Knochenhauer ES Key TJ Kahsar-Miller M Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study J Clin Endocrinol Metab 1998 83 Diamanti-Dandarakin E Kouli CR Blergiele AT A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile J Clin Endocrinol Metab 1999 84 Asunción M Calvo RM San Millan JL Aprospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain J Clin Endocrinol Metab 2000 85 Govind A Obhrai MS Clayton RN Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families J Clin Endocrinol Metab 1999 84 Legro RS Driscoll D Strauss JF Fox J Dunaif A Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome: Proc Natl Acad Sci USA 1998; 95:14956 - 14960 Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome: Proc Natl Acad Sci USA 1998; 95:14956 - 14960 Sharma A Atiomo W Recent developments in polycystic ovary syndrome Curr Obstet Gynecol 2003 13 ACOG Practice Bulletin: Polycystic Ovary Syndrome Obstet Gynecol 2002 100 Hardiman P Ouma SP Atiomo W Polycystic ovary syndrome and endometrial carcinoma Lancet 2003 361 Balen AH Tan SL MacDougall J Jacobs HS Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserilin Hum Reprod 1993 8 Taylor A Barbieri R Steroid hormone metabolism in polycystic ovary syndrome Steroid hormone metabolism in polycystic ovary syndrome 2004 UpToDate. Rose, BD (Ed), UpTodateWellesley, MA Nestler JE Jakubowicz DJ Decreases in ovarian cytochrome P450c 17 -alpha activity and semm free testosterone after reduction of insulin secretion in polycystic ovary syndrome N Engl J Med 1996 335 Azziz R Androgen excess is the key element in polycystic ovary syndrome Fertil Steril 2003 80 Lobo R What are the key features of importance in polycystic ovary syndrome? Fertil Steril 2003 80 Adams J Polson DW Franks S Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism BMJ 1986 293 Kovacs A Polycystic ovarian disease: an overview Reviews Gynaecol Pract 2004 4 Bengtsson C Bjorkelung C Lapidus L Lissner L Association of serum lipid concentration and obesity with mortality in women: 20 year follow up of participant in prospective population study in Gothenburg, Sweden BMJ 1999 307 Dunaif A Hyperandrogenemia is necessary but not sufficient for polycystic ovary syndrome Fertil Steril 2003 80 Dunaif A Segal KR Futterweit W Dobrjaosky A Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome Diabetes 1989 38 Ehrmann DA Barnes RB Rosenfield RL Cavaghan MK Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome Diabetes Care 1999 22 Legro RS Kunselman AR Dodson WC Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective controlled study in 254 affected women J Clin Endocrinol Metab 1999 84 United States Preventive Services Task Force Guidelines: Screening for type 2 diabetes mellitus in adults: Recommendations and rationales United States Preventive Services Task Force Guidelines: Screening for type 2 diabetes mellitus in adults: Recommendations and rationales 2004 UpToDate, Rose, BD (Ed), UpToDateWellesley, MA Wild S Pierpoint T McKeigue P Jacobs H Cardiovascular disease in women with polycystic ovary syndrome at long-term follow up; a retrospective cohort study Clin Endocrinol 2000 52 Sukalich S Guzick D Cardiovascular Health in Women with Polycystic Ovary Syndrome Sem Reprod Med 2003 21 Royal College of Obstetricians and Gynecologists: Long - Term Consequences of Polycystic Ovary Syndrome Royal College of Obstetricians and Gynecologists: Long - Term Consequences of Polycystic Ovary Syndrome 2002 Solomon Ca Hu FB Dunaif A Menstrual cycle regularity and risk for future cardiovascular disease J Clin Endocrinol Metab 2002 87 Legro R Polycystic Ovary Syndrome and Cardiovascular Disease: A Premature Association? Endocr Rev 2003 24 Guzick D Polycystic Ovary Syndrome Obstet Gynecol 2004 103
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400005 Análisis de la concordancia prescripción- administración de analgésicos durante el postoperatorio inmediato Sáenz-Campos Desirée Sánchez-Arredondo Carmen Ma ,Universidad de Costa Rica Escuela de Medicina ,Caja Costarricense de Seguro Social Hospital San Juan de Dios 10 2005 2005 47 186 191

Objetivo: Comparar la prescripción con la administración de analgésicos en pacientes ortopédicos durante el postoperatorio inmediato (primeras 24 horas). Procedimiento: Estudio observacional. Del expediente se registró prescripción y aplicación de medicamentos a 60 pacientes (30 hombres y 30 mujeres) con cirugía ortopédica electiva de extremidades en un hospital general; ASA I (80%) y II (20%), ninguno con alergia documentada a analgésicos o antiinflamatorios; se realizó confirmación cruzada con pizarra de enfermería y entrevista al paciente. Indicadores: cumplimiento de prescripción (número total de dosis administradas/120 dosis de diclofenaco ó 180 dosis de tramadol), cumplimiento de dosis (aplicación real de dosis prescrita: diclofenaco 75 mg y 50 mg de tramadol), cumplimiento de intervalos (desvío temporal de 12 horas para diclofenaco y 8 horas para tramadol) y variaciones prescripción-administración (aplicaciones adicionales y omisiones). Análisis descriptivo. Resultados: Todos con diclofenaco prescrito; 63.3% con 75 mg (1 ampolla) cada 12 horas vía intramuscular y tramadol 50 mg (¹/2 ampolla) subcutáneo cada 6 horas. Diclofenaco: 50% recibió una única dosis, 33.4% con 2 dosis y solo 1 con 3 dosis; cumplimiento de prescripción = 59.2 %. La segunda dosis a 14.86 + 4.33 horas, cumplimiento de intervalos = 18.3% (atraso +3 horas). Tramadol: 68.0% recibió 1 dosis y 20.0% con 2 dosis; cumplimiento de prescripción = 32.8%. La segunda dosis a 12.81 + 6.07 horas, cumplimiento de intervalos = 37.5% (atraso +5 horas). Para ambos fármacos, cumplimiento de dosis = 100%. Variaciones 21.7%: 2 pacientes con tramadol sin estar prescrito y omisión del medicamento en 11 pacientes. Conclusiones: La administración evaluada no se ajusta al perfil de prescripción médica, al menos durante las primeras 24 horas de postoperatorio inmediato y bajo atención hospitalaria, lo cual debe mejorarse en procura del control óptimo para beneficio de los pacientes.

Objective: To compare the prescription and administration of postopertaive analgesics (first 24 hours) in patients who underwent orthopedic surgery. Methods: Observational study. Information was obtained from the medical charts of 60 patients (30 female and 30 male), who underwent elective orthopedic surgery of the extremities at a general hospital; ASA I (80%) and ASA II (20%), none with documented allergy to analgesics or anti-inflammatory agents. We performed crossed confirmation with the nurse' s chartboard and patients interviews. Variables: fulfillment of the prescription (total administerd doses: 120 doses of diclofenac or 180 doses of tramadol), fulfillment of the dose (real application of prescribed dose: diclofenac 75 mg and tramado150 mg), fulfillment of intervals (temporary deflection of 12 hours for diclofenac and of 8 hours for trramadol), and prescription-administration variations (additional applications or omissions). Descriptive analisis. Results: All patients were prescribed with diclofenac; 63.3% with 75 mg (1 vial) every 12 hours LM., and tramadol 50 mg (1/2 vial) every 6 hours S.C. Diclofenac: 50% received only one dose, 33.4% two doses, and one patient received tree doses; prescription' s fulfillment = 59.2%. Second dose 14.86 + 4.33 hours after the first dose, interval's fulfillment = 18.3% (+3 hours delay). Tramadol: 68.0% received one dose and 20% received two doses; prescription's fulfillment = 32.8%. Second dose 12.81 + 6.07 hours after the dirst dose; interval' s fulfillment = 37.5% (+5 hours delay). For both drugs: dose's fulfillment = 100%. Variations 21.7%: 2 patients received tramadol without prescription, the administration of the drug was omitted in 11 patients. Conclusions: The observed drug administration does not adjust to the prescribing profile, at least for the first 24 hours after surgery as inpatient care. The drug administration must improve towards the patients benefit.

 dolor agudo dolor postoperatorio diclofenaco tramadol prescripción cumplimiento calidad acute pain postoperative pain diclofenac tramadol prescription compliance Gottschalk A Smith DS New concepts in acute pain therapy: preemtive analgesia Am Fam Physician 2001 63 Sáenz-Campos D Gamboa A Control del dolor en el postoperatorio inmediato y análisis de la prescripción de analgésicos Acta Méd Costarric 1998 40 Sáenz-Campos D Control del dolor postoperatorio inmediato y análisis de la prescripción de analgésicos en el Hospital San Juan de Dios Acta Méd Costarric 1999 41 Baños JE Bosch F Problemas específicos de la terapia antiálgica en el medio hospitalario Med Clin (Barc) 1996 106 Carpenter R.L Optimizing postoperative pain management Am Fam Physician 1997 56 Carr D Preempting the memory of pain JAMA 1998 279 Kissin I Preemptive analgesia Anestesiology 2000 93 Kehlet H Holte K Effect of postoperative analgesia on surgical outcome Br J Anaesthesiol 2001 87 Wolf CJ Chong MS Preemptive analgesia - treating postoperative pain by preventing establishment of central sensitization Anest & Analg 1993 77 Eledjam JJ Ripart J Viel E Guidelines on postoperative analgesia: Conclusions of the French consensus conference Guidelines on postoperative analgesia: Conclusions of the French consensus conference Sáenz-Campos D Analgésicos, antipiréticos, antiinflamatorios no esteroidales, revisión terapéutica Fármacos 1999 12 Abramowics M Fármacos para el dolor The Medical Letter 1999 40 Lista Oficial de Medicamentos Lista Oficial de Medicamentos 2004 San José Caja Costarricense de Seguro Social Dolin SJ Cashman IN Bland JM Effectiveness of acute postopera tive pain management: 1. Evidence from published data Br J Anaesthesiol 2002 89 What is drug utilization research and why is it needed?: In: Introduction to drug utilization research What is drug utilization research and why is it needed?: In: Introduction to drug utilization research 2004 Geneve WHO Elwyn G Edwards A Britten N Doing prescribing: how doctors can be more effective BMJ 2003 327 Jones G Prescribing and taking medicines BMJ 2003 327
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400006 Sobrevida en pacientes con cáncer de cervix Ortiz-Barboza Adolfo Leal-Mateos Manrique ,Ministerio de Salud ,Ministerio de Salud Vigilancia de la Salud San José 10 2005 2005 47 192 195

Objetivo: Estimar la probabilidad acumulada de sobrevida a cinco años, de una cohorte de pacientes diagnosticadas con cáncer de cervix durante 1999. Metodología: Para el análisis de la información se utilizaron distribuciones de frecuencia con valores absolutos y porcentuales, medidas de tendencia central y de dispersión. La relación entre variables cualitativas se efectuó mediante la prueba estadística de Chi cuadrado (X2). El nivel de significancia se fijó en p < 0.05. La probabilidad acumulada de sobrevida fue realizada mediante el método de Kaplan-Meier. La comparación entre los tiempos de sobrevida se realizó mediante el test de rangos logaritrnicoso El nivel de significancia fue fijado en p < 0,05. Resultados: Se analizaron 778 casos al final del periodo de estudio fallecieron 91 pacientes. La probabilidad acumulada de sobrevida a los cinco años para toda la población fue del 88,3%. Las pacientes a las cuales se les detectó carcinoma in situ al momento del diagnóstico, presentaron una probabilidad acumulada de sobrevida de 98,8%, mientras que a aquellas a quienes se les detectó un carcinoma invasor, fue del 68,3%. Esta diferencia fue estadísticamente significativa. La probabilidad acumulada de sobrevida para las pacientes diagnosticadas con carcinoma de células escamosas fue de un 89%, mientras que para aquellas diagnosticadas con adenocarcinoma fue de un 80%. Esta diferencia no fue estadísticamente significativa. Conclusiones: Los resultados obtenidos muestran valores superiores a los determinados en otros países con un nivel de desarrollo inferior al nuestro, y similares a los encontrados en naciones desarrolladas. Con los resultados obtenidos, se podría suponer que las probabilidades acumuladas de sobrevida son mayores en aquellas pacientes a quienes se les realiza el diagnóstico de cáncer de cervix en edades tempranas, y que esto puede relacionarse con la alta proporción de carcinomas in situ diagnosticados en esta etapa de la vida y cuyo pronóstico es más favorable.

Objective: To estimate 5 year calculate the five-year cumulative survival probability of a patient cohort diagnosed with interine cervical cancer during 1999. Methods: To analyse of the information, we used frequency distributions with absolute values as well as percentages, measures of central tendency as well as of variance. The relation ship between cualitative variables was done by means of a chi square statistical test. A p value less or equal to 0.05, was significant. The cumulative survival probability was done using the Kaplan-Meier method. The comparison between the survival times was done using a logarithmic range test. The level of significance was again fixed at less or equal to 0.05. Results: A total of 778 cases were studied at the end of the study period, 91 patients had died. The 5 year, cumulative survival probability for the whole population was 88.3%. The patients in which carcinoma in situ was detected at the time of diagnosis, showed a cumulative survival probability of 98.8% while those with invasive carcinoma had a value of 68.3%. This difference was statistically significant. The cumulative survival probability for the patients diagnosed with squamous cell carcinoma was 89% while those with adenocarcinoma had a value of 80%. This difference did not fall within the range of statistical significance, though. Conclusions: If we compare our results with similar investigations done elsewhere, we can see that our values are superior to those seen in countries with a level of development lower than that of Costa Rica and that, they are similar of those of developed countries. With the results obtained, we could as sume that the cumulative survival probabilities are greater in those patients in whom the diagnosis of cervical cancer is done at a young age; in addition, this may be related to the high proportion of carcinoma in situ cases diagnosed at this stage in life. when the prognosis for this illness is more favorable.

 Sobrevida cáncer cervix cáncer cervical survival cancer cervix cervical cancer International Association of Cancer Registres: Cancer incidence in five continents International Association of Cancer Registres: Cancer incidence in five continents 2002 VIII Lyon IARC Sánchez M Vargas R Muñoz Ci Incidencia y mortalidad del cáncer en Costa Rica 1997 Muñoz Ci Incidencia y mortalidad del cáncer en Costa Rica 1997 2002 San José Ministerio de Salud Murphy Ci Oncología clínica 1996 Murphy Ci Oncología clínica 1996 1996 Washington D.C OPS Quinn M Babb P Jones J Allen E Effect of screening on incidence of mortality from cancer of cervix in England: Evaluation based on routinely collected statistics BMJ 1999 318 Raflle A Alden B Quinn M Babb P Brett M Outcomes of screeninig to prevent cancer: Analysis of cumulative incidence of cervical abnormality and modeling of cases and deaths prevented BMJ 2003 326 Peto J Gilham C Fletcher O Matthews F The cervical cancer epidemic that screening has prevented in tha UK Lancet 2004 364 Análisis sectorial de salud Análisis sectorial de salud 2002 San José Ministerio de Salud Nandakumar A Anatha N Venugopal TC Incidence, mortaity and survival in cancer of the cervix in Bangalore, India Brit J Cancer 1995 71 Wabinga H Ramanakumar AV Banura C Lugawa A Nambooze S Parkin DM Brit J Cancer 2003 89 Chokunonga E Ramanakumar AV Nyakabau AM Borok M Chirenje M Sankila R Survival of cervix cancer patients in Harare, Zimbabwe Int J Cancer 2004 109 Flores L Zamora S Salazar E Lazcano P Análisis de supervivencia: Aplicación en una muestra de mujeres con cáncer cervical en México Rev Salud Pública Méx 2000 42 Berrino F Capocaccia R Estéve J Gatta G Micheli A Hakulinen T Survival of cancer patients in Europe: The EUROCARE-2 study Survival of cancer patients in Europe: The EUROCARE-2 study 1999 Lyon IARC Sánchez P Higuera S Cáncer de cervix uterino SEMERGEN 2002 28 Brenner H Long-Term survival rates of cancer patients achieved by the end o 20" century: A period analysis Lancet 2002 360 Saslow D Runowicz C Solomon D Moscicki AB Smith R Eyre H American Cancer Society guideline for early detection of cervical neoplasia an cancer Cancer J Clin 2002 52
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400007 La práctica actual de la medicina Salazar V Carlos , 10 2005 2005 47 196 196 Herrerias C Dellert E U sing evidence and experience to achieve excellence Chest Soundings 2005 19 Isaacs D Fitzgerald D Seven altematives to evidence based medicine BMJ 1999 319
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400008 Poliorquidismo Orlich-Castelán Claudio Murcia-Quirós Osvaldo ,Hospital San Juan de Dios Servicio de Urología San José Costa Rica 10 2005 2005 47 197 198

El poliorquidismo es una anomalía congénita muy rara de la que se han reportado solamente unos 70 casos en la literatura mundial. Se cree que es resultado de la división transversa de la cresta urogenital. Se han reportado como enfermedades coincidentes: la criptorquídea, la hernia inguinal, el varicocele y la torsión testicular. La gran mayoría de pacientes tienen una fertilidad conservada y se han reportado unos pocos casos de tumores testiculares.

We herein report a case of polyorchidism which is a very unusual condition. There have been only about 70 cases reported in the literature. It may result from the transverse division of the urogenital ridge. Accompanying disorders include: mal descended testicles, inguinal hernia, varicocele, testicular torsion and testicular tumors.

 poliorquidismo enfermedad congénita uropatología polyorquidism congenital disease uropathology Spranger R Gonst M Kuhn M Polyorquidism: a strange anomaly with unsuspected properties J. of Urol 2002 168 Thum, Ci Polyorquidism: case report and review of the literature J. of Urol 1991 145 Singer B.R Donaldson J Jackson D Polyorquidism: functional classification and management strategy Urol 1992 39
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400009 Linfoma de Burkitt en un portador de granulomatosis de Wegener Rodríguez-Castro Kryssia Zamora-Barquero Henry , 10 2005 2005 47 199 201

Se reporta el caso de un paciente costarricense portador de granulomatosis de Wegener, en tratamiento con ciclofosfamida y prednisona, quien desarrolla un linfoma de Burkitt que lo lleva a la muerte. Se menciona la posible relación entre estas dos patologías.

This is a report of a costarrican male with Wegener' s granulomatosis undergoing treatment with prednisone and cyclophosphamide, he developed a fatal Burkitt' s lymphoma. The possible relationship between these two disorders is addressed.

 Granulomatosis de Wegener Linfoma de Burkitt inmunosupresión enfermedades linfoproliferativas Weneger's granulomatosis Burkit's lymphoma lympho-proliferative disorders Cos S Harper L Cockwell P Adu D Howie AJ ABC of arterial and vascular disease: Vasculitis BMJ 2000 320 Talar-Williams C Hijazi YM McClellan WM Linehan MW Hallaban CW Lubensky I Kerr GS Hoffman GS Fauci AS Sneller MS Cyclophosphamide-Induced Cystitis and BIadder Cancer in Patients with Wegener Granulomatosis Aun Intem Med 1996 124 Blundell AG Roe S Wegener' s granulomatosis presenting as a pleural effusion BMJ 2003 327 Uppal S Saravanappa N Davis JP Farmer Goldsmith DJA. Lesson of the week: Pulmonary Wegener's granulomatosis misdiagnosed as malignancy BMJ 2001 322 Daily J P Sadeghi S A 35-Year-Old Man with a Painful Abdominal Mass and Fever N Engl J Med 2000 342 Isaacson P G Gastrointestinal Iymphomas of T- and B-cell types Mod PathoI 1999 12 Practice Guidelines in Oncology: National Comprehensive Cancer Network Version 1 Practice Guidelines in Oncology: National Comprehensive Cancer Network Version 1 2005 Jaffe ES Hematopathology: Integration of morphologic features and biologic markers for diagnosis Mod Pathol 1999 12 Ramos-Casals M Trejo O García-Carrasco M Cervera R De la Red G Gil V López-Guillermo A Ingelmo M Font J Triple Association Between Hepatitis C Virus Infection, Systemic Autoirnmune Diseases, and B Cell Lymphorna J RheuniatoI 2004 31 Groves FD Linet MS Travis LB Devesa SS Cancer Surveillance Series: Non-Hodgkin's Lymphoma Incidence by Histologic Subtype in the United States From 1978 Through 1995 J Natl Cancer Inst 2000 92 Ambrus J L Fauci A S Diffuse histiocytic Iymphoma in a patient treated with cyclophosphamide for Wegener' s Granulomatosis Am J Med 1984 76 Colburn K K Cao J D Krick E H Mortensen S E Wong L G Hodgkin' s Iymphoma in a patient treated for Wegener' s Granulomatosis with cyclophosphamide and azatiophrine J RheurnatoI 1985 12 Lonie S Daoust P R Schwartz R S Immunodeficiency and the pathogenesis of non-Hodgkin's Iymphoma Semin Oncol 1980 7 Knowles D M Immunodeficiency-Associated Iymphoproliferative disorders Mod PathoI 1999 12 Thompson M P Kurzrock R Epstein-Barr virus and cancer Clin Cancer Res 2004 10 Chabay P A De Matteo E N Aversa L Maglio S Grinstein S Preciado M V Assessment of Epstein-Barr Virus Association With Pediatric Non-Hodgkin Lymphoma in Immunocompetent and in Irnmunocompromised Patients in Argentina Arch Pathol Lab Med 2002 126
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400010 Obstrucción intestinal secundaria a vólvulo espléndico en un paciente pediátrico Murillo-Ortiz Juan Pablo Vargas-Salas Marco V ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera 10 2005 2005 47 202 204

La torsión de un bazo errante es rara. La forma de presentación varia desde dolor abdominal intermitente hasta un cuadro de abdomen agudo. Se presenta un caso clínico de un paciente pediátrico con obstrucción intestinal secundaria a la torsión de un bazo errante

The occurrence of a wandering spleen is unusual, and even more a tortioned wandering spleen. The patients may present with various syrnptoms ranging from mild intermittent abdominal pain to an acute abdomen. We present a patient with intestinal obstruction secondary to torsion of a wandering spleen

 vólvulo de intestino medio vólvulo esplénico bazo errante midguent volvulous splenic volvulous wadering spleen Allen Keith B Andrews Gibbs. Pediatric wandering spleen - The case for splenopexy: Review of 35 reported cases in the literatnre J Pediatr Surg 1989 24 Ng T Lessin M Luks F Wallach M Wesselhoeft C Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragrnatic hernia J Pediatr Surg 1997 32 Zivkovic S Sutureless "button and hole" splenopexy Pediatr Surg Int 1998 13 Greig D Sweet E.M Drainer I Splenic torsion in a wandering spleen, presenting as an acute abdominal mass J Pediatr Surg 1994 29 Peitgen K Schweden K Management of intermittent splenic torsion ("Wandering spleen"): A review Eur J Surg 1995 161 Seashore J Mcintosh S Elective splenopexy for wandering spleen J Pediatr Surg 1990 25 Stringel G Soucy P Mercer S Torsion of the wandering spleen: Splenectomy or splenopexy J Pediatr Surg 1982 17 Schrnidt S Andrews G White J The splenic snood: An improved approach for the management of the wandering spleen J Pediatr Surg 1992 27 Cimaz R Mensi C Angelo E Fantola E Milone V Biasio L Safety and immunogenicity of a conjugate vaccine against Haemophilus influenzae type b in splenectomized and nonsplenectomized patients whit Cooley anemia J Infect Disease 2001 183 Schiller M The spleen en O'Neill J, Rowe M. Pediatric surgery The spleen en O'Neill J, Rowe M. Pediatric surgery St Louis^eMissouri Mosby-Year book,1998,1545-1554
S0001-600220050004 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000400011 Costa Rica en el Exterior , 10 2005 2005 47 205 205