Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720150007&lang=pt vol. 143 num. 7 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Effect of educational level on the prognosis of acute myocardial infarction</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700001&lng=pt&nrm=iso&tlng=pt Background: Socioeconomic status is associated with cardiovascular mortality. Aim: To evaluate the effect of educational level, on the prognosis of patients with acute myocardial infarction in Chile. Material and Methods: Cohort study of 3,636 patients aged 63.1 ± 13.2 years, 27% women, hospitalized in 16 centers participating in the Chilean Myocardial Infarction Registry (GEMI) between 2009 and 2012. Vital status was obtained from the National Mortality Database. Patients were divided, according to educational level, in four groups, namely none (no formal education), basic (< 8 years), secondary (8-12 years) and tertiary (&gt; 12 years). Crude and adjusted (age, sex, cardiovascular risk factors and treatments) hazard ratios (HR) were estimated using Cox regression models. Results: The distribution by educational level was 3.2% none, 31.8% basic, 43.0% secondary and 22.0% tertiary. During a median follow-up period of 22 months (interquartile range 11-37 years), 631 patients died (17.3%), of whom 198 died during hospitalization (5.5%). The 30 day case-fatality rate according to educational level was 3.4% in tertiary, 4.7% in secondary, 11.9% in basic, 19.1% in none (p < 0.0001). Among patients surviving the first 30 days, the case-fatality rate was 4.4%, 8.6%, 14.6% and 27.0%, respectively (p < 0.0001). The increased risk of death for groups with lower education compared with individuals with tertiary education, persisted in the multivariate analysis with a hazard ratio for secondary education 1.58 (95% confidence intervals (CI), 1.18-2.10); for basic education 1.90 (95% CI, 1.41-2.47) and for none 3.50 (95% CI, 2.35-5.21). Conclusions: A lower educational level was associated with a worse prognosis in patients with myocardial infarction, even after controlling for potential confounding factors. <![CDATA[<strong>Development of malignant tumors in patients with inflammatory bowel disease</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700002&lng=pt&nrm=iso&tlng=pt Background: The chronic inflammation of the intestinal mucosa, the extra-intestinal manifestations of the disease and the immunosuppressive treatment of inflammatory bowel disease may increase cancer risk. Aim: To report the demographic and clinical features of patients with IBD who developed a malignant tumor. Material and Methods: Retrospective analysis of an IBD patient registry of a private clinic, diagnosed between 1976 and 2014. Results: 437 subjects were included, aged 15-88 years (58% women). Seventy two percent of patients had ulcerative colitis. The median time of follow up was 6 years. Ten patients (2.3%) developed a malignant tumor. In four, the tumor could be related to IBD (two colorectal cancers, one cholangiocarcinoma and one chronic myeloid leukemia (CML)). Two of 45 patients treated with biological therapy developed a tumor (CML and hypernephroma). Three of 170 patients on immunosuppressive treatment developed tumors. Only one had a tumor possibly related with the use of azathioprine (non-melanoma skin cancer). In only two patients, the treatment was changed at the time of their cancer diagnosis, from immunosuppressive medications to mesalamine. Conclusions: Only a small proportion of these patients with IBD developed a malignant tumor. The treatment of IBD has to be determined by the severity of the disease and not by the fear of developing a neoplasia. Following recommendations is fundamental to decrease the possibility of developing this complication. <![CDATA[<strong>Students’ perceptions comparing standardized and non-standardized oral exams in internal medicine</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700003&lng=pt&nrm=iso&tlng=pt Background: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. Aim: To compare students’ perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). Material and Methods: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. Results: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. Conclusions: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade. <![CDATA[<strong>Squamous cell carcinoma of the lip survival rate</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700004&lng=pt&nrm=iso&tlng=pt Background: Squamous Cell Carcinoma (SCC) of the lip represents about 20% of all oral carcinomas. It is more common in men, peaking during their sixth and seventh decade, and is more prevalent in the lower lip. Aim: To determine the five years survival rate of Chilean patients with lip SCC. Material and Methods: The registry of the Chilean National Cancer Institute was reviewed to retrieve the clinical records of patients with lip SCC. Information about age, sex, alcohol consumption, smoking, degree of pathological differentiation, lip location, type of treatment and metastases was recorded. Survival was determined with death certificates from the National Identification Service. Results: Seventy four patients were identified. Their 5-year survival was 73%. Conclusions: The survival rate of this group of patients is lower than that of patients from Unites States who have an 89.5% survival, according to the Surveillance, Epidemiology, and End Results Program of the North American National Cancer Institute. <![CDATA[<strong>An exploratory study of functional literacy on health care behaviors in Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700005&lng=pt&nrm=iso&tlng=pt Background: Health Literacy is the set of skills that constitute the ability to perform reading and numerical tasks to function in the health care environment. People with functional illiteracy are unable to understand written documents and therefore sanitary information. Aim: To explore the effects of functional illiteracy on personal health care behaviors in Chile. Material and Methods: Using the Chilean Social Characterization Survey of 2006, respondents were separated into those that had read a book in the last year and those that had not as a proxy variable for functional literacy. Using econometric models, the impact of this variable on having a Papanicolaou (PAP) smear done and consulting in primary health clinics rather than in emergency services, was explored. Results: The survey is nationally representative, and 76% interviewees declared not having read a book in the last year. Probability of having a PAP smear done during the last three years was higher among women who had read a book with an OR of 1.19 (1.15-1.25). Likewise, the probability of consulting in emergency services rather than in primary health clinics was lower among those who had read a book with an OR of 0.85 (0.80-0.91). Conclusions: This study provides evidence of possible impacts of low functional literacy in health care behaviors in the Chilean population. <![CDATA[<strong>Plasma ghrelin levels in the late postoperative period of vertical sleeve gastrectomy</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700006&lng=pt&nrm=iso&tlng=pt Background: Plasma ghrelin levels may decrease after vertical sleeve gastrectomy, probably due to the excision of a large portion of the gastric fundus. It is worth exploring the long term effects of this surgical procedure on ghrelin levels and their associations with changes in body weight. Aim: To assess ghrelin levels and changes in body weight, one and five years after a vertical sleeve gastrectomy. Material and Methods: Plasma ghrelin was measured prior to gastric sleeve gastrectomy, immediately after surgery and BMI was controlled at one and five years of the postoperative period in 16 and 10 obese patients, respectively. Mean baseline body mass index was 40.4 ± 6 kg/m². Results: Ghrelin decreased in 10 patients and increased in six during the long term postoperative period. At one year, mean body mass index decreased to 25.1 ± 1.6 kg/m². Changes in weight and ghrelin levels had no relationship whatsoever. At five years of follow up, body mass index had increased to 29.9 ± 2.5 kg/m², again without any association with ghrelin levels. Conclusions: Ghrelin levels may decrease or increase after vertical sleeve gastrectomy and have no association with changes in body weight. <![CDATA[<strong>Delay in the diagnosis of Parkinson’s disease in a Chilean public hospital</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700007&lng=pt&nrm=iso&tlng=pt Background: Early diagnosis is fundamental in patients with Parkinson’s disease (PD) to improve their quality of life. Aim: To determine the latency in the diagnosis of Parkinson’s disease (PD) after the onset of motor symptoms. Patients and Methods: Prospective study carried out during 16 months in a public hospital. Two hundred newly diagnosed patients aged 41 to 90 years (50% women), were included and analyzed. Results: The lapse between the first symptom -more commonly tremor- and the diagnosis made by a neurologist ranged from 1 to 84 months (19.1 ± 13.8). In 39% of patients, it was done in the first year, in 26% during the second year and in 35% of patients, it took more than two years. The referral by a general practitioner had a delay ranging from 1 to 36 months. Sixty nine and 95% of patients were evaluated within the first 6 months after referral if they came from primary care or the same hospital, respectively. Twenty six percent of patients were classified in stages III to V of Hoehn & Yahr’s staging and the Parkinson’s Disease Rating Scale motor examination ranged from 5 to 81 points, mean 24 (± 12.8). Conclusions: The diagnosis of PD has a delay in a public hospital that could be influenced by the referral system. <![CDATA[<strong>Frequency of holoprosencephaly in Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700008&lng=pt&nrm=iso&tlng=pt Background: Holoprosencephaly is a structural anomaly of the brain that consists in a defect of the prosencephalon development that leads to face and neurological defects of variable intensity. Aim: To estimate holoprosencephaly prevalence at birth. Patients and Methods: All cases of holoprosencephaly, born alive or stillbirths, registered in the 15 Chilean Hospitals of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) between 1972 and 2012, were studied. Craniofacial and other anomalies found in newborns affected by holoprosencephaly are described. Results: Fifty five cases of holoprosencephaly (58% males) were found among the 798.222 registered births (rendering a prevalence at birth of 0.69 per 10.000 newborns). The most common cranial defect was medial cleft lip with cleft palate (27.3%), bilateral cleft lip (11%) or both (38.2%), cyclopia (14%), single nostril (10.9%) and proboscis (9.1%). Eleven percent cases had a trisomy 13. A slight increase in prevalence over time was observed. Conclusions: Holoprosencephaly has a low frequency in Chile and is associated to trisomy 13. The increase in prevalence could be explained by a better prenatal diagnosis (ultrasonography). <![CDATA[<strong>Comparison of two methods to assess causality of adverse drug reactions</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700009&lng=pt&nrm=iso&tlng=pt Background: Assessment of causality is an essential part of pharmacological surveillance. Aim: To compare the causality assessment of suspected adverse drug reactions (ADRs) using algorithms proposed by Karch-Lasagna (K & L) and the World Health Organization (WHO). Material and Methods: All spontaneous reports of suspected ADRs in a pediatric ward of a regional hospital were included. Causality was categorized as definitive, probable, possible, conditional or unlikely. The agreement between K & L and WHO algorithms was assessed using binomial test proportions and kappa coefficients. Results: One hundred thirty reports of ADRs in 126 patients aged 2 to 11 years were analyzed. The suspected medications were antineoplastic drugs in 59% of cases and antimicrobials in 23%. The most common affected system was the skin and appendages in 35%. Using K & L algorithm, causality was categorized as definitive in 10% of cases, probable in 28.5%, possible in 35.4%, conditional in 23.1% and unlikely in 3.0%. Using WHO algorithm, the figures were 2.3, 34.6, 59.2, 2.3 and 1.5%, respectively. The degree of agreement between K & L and WHO algorithms was 32.3% (kappa = 0.004). Conclusions: K & L attributed a higher level of ADR causality than WHO algorithm. <![CDATA[<strong>An update on postpartum depression</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700010&lng=pt&nrm=iso&tlng=pt Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers’ methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered. <![CDATA[<strong>Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700011&lng=pt&nrm=iso&tlng=pt Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use. <![CDATA[<strong>A brief magnetic resonance imaging protocol for spondyloarthritis</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700012&lng=pt&nrm=iso&tlng=pt Spondyloarthritis is a group of diseases that seriously hampers quality of life. Diagnostic criteria, in which images play an important role, have evolved over time. The most recent diagnostic criteria, published in 2009, included magnetic resonance imaging (MRI) of the sacroiliac joints for the first time. This technique achieves an early diagnosis and provides a useful tool for the evaluation and prediction of response to biological therapy. Herein, we describe the different MRI findings in spondyloarthropathies. We also highlight the use of a protocol that includes the sacroiliac joints and spine and that does not consider the routine use of paramagnetic contrast. <![CDATA[<strong>History and functions of Chilean ophthalmologic primary care units</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700013&lng=pt&nrm=iso&tlng=pt The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net. <![CDATA[<strong>Why should we remain in service when facing the threat of Ebola virus infection?</strong>: <strong>Some reflections</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700014&lng=pt&nrm=iso&tlng=pt Currently, the Ebola virus has been classified by the WHO as “an international public health emergency” that has highlighted among other things, the enormous importance of proper and timely medical care. However, the complexity of this new health scenario, mainly due to personal risk in the event of infection, means that professionals are directly faced with situations of great ethical conflict since there is a competition between their duties to patients, colleagues, society and those directed to their own safety. The reasons given by those professionals who respond positively to the duties of their patients have been categorized into three items, namely: professional ethics, the need to help and work ethics. The philosophical foundations of these responses find their roots in the compassion and sense of responsibility that arise when we face helplessness. <![CDATA[<strong>Academic achievement, engagement and burnout among first year medical students</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700015&lng=pt&nrm=iso&tlng=pt Background: Stress may affect the sense of wellbeing and academic achievement of university students. Aim: To assess the relationship of academic engagement and burnout with academic achievement among first year medical students. Material and Methods: The Utrecht Work Engagement Scale-Student and Maslach Burnout Inventory Student Survey (MBI-SS) were applied to 277 first year medical students of four universities. Their results were correlated with the grades obtained in the different courses. Results: Moderately high engagement and low burnout levels were detected. There was a high level of satisfaction with studies and a moderate exhaustion level. Academic achievement was associated with the degree of engagement with studies but not with burnout. Conglomerate analysis detected a group of students with high levels of wellbeing, characterized by high levels of academic engagement and low burnout. Other group had moderate levels of engagement and lack of personal fulfilment. Other group, identified as extenuated, had high levels of personal exhaustion and depersonalization. Finally the disassociated group had a low academic engagement, low emotional exhaustion, high levels of depersonalization and lack of personal fulfillment. Conclusions: Academic achievement is associated with the level of engagement with studies but not with burnout. <![CDATA[<strong>Insulin autoimmune syndrome</strong>: <strong>Report of two cases</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700016&lng=pt&nrm=iso&tlng=pt Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response. <![CDATA[<strong>Peritoneal myofibroblastic tumor successfully treated with infliximab</strong>: <strong>Report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700017&lng=pt&nrm=iso&tlng=pt Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions. <![CDATA[<strong>Creativity and Neuroscience</strong>: <strong>An essential binomial in educational context</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700018&lng=pt&nrm=iso&tlng=pt Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions. <![CDATA[<strong>Neuroscience and physical activity</strong>: <strong>A new perspective in educational context</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700019&lng=pt&nrm=iso&tlng=pt Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions. <![CDATA[<strong>An appraisal of the SF-12 Questionnaire</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700020&lng=pt&nrm=iso&tlng=pt Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions. <![CDATA[<strong>An appraisal of the SF12 Questionnaire (Reply)</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000700021&lng=pt&nrm=iso&tlng=pt Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.