Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720000003&lang=es vol. 128 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Mutación del gen p53 en el cáncer de la vesícula biliar]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300001&lng=es&nrm=iso&tlng=es Background: Gallbladder cancer frequency and mortality renders it one of the most important neoplastic diseases in Chile. P53 tumor suppressor gene has been studied in most types of cancer, but there is scarce information about it in gallbladder cancer. Aim: To study the frequency of P53 gene mutation in gallbladder cancer in the ninth region of Chile. Material and methods: In 25 pathological samples of gallbladder cancer, the direct amplification and sequencing of p53 gene exons 5,6,7,8-8 was possible. Results: Seventeen punctual mutations were observed in 13 cases (52%). There were 10 transitions, 5 transversions, one insertion (codon 194) and one deletion (codon 186). Eight cases had mutations in exon 5, six had mutations in exon 6, two had mutations in exon 7 and one had mutations in exons 8-9. In 14 of 25 cases, gene p53 protein was positive. When immunohistochemical expression of gene p53 protein was positive in more than 20% of cells, there was a high correlation between genetic alterations and immunohistochemical expression of the protein, with a specificity, sensitivity, positive and negative predictive values over 80%. Conclusions: P53 gene mutation is observed in a high proportion of gallbladder cancers at it can be accurately detected with conventional immunohistochemical techniques. The importance of this gene in the genesis of this carcinoma should be determined studying preneoplastic lesions and early carcinomas <![CDATA[<I>Helicobacter pylori</I> y gastritis crónica: relación entre infección y actividad inflamatoria en población de alto riesgo de cáncer gástrico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300002&lng=es&nrm=iso&tlng=es Background: Helicobacter pylori has been involved in gastric epithelial cell damage and gastric gland loss or atrophy. Aims: to evaluate role of Helicobacter pylori infection in acute and chronic changes of chronic gastritis in a high gastric cancer-risk population. Material and methods: 200 patients with chronic gastritis were selected from pathological files of Temuco Hospital. A complete histopathological protocol was fulfilled considering the presence of infection by Helicobacter pylori-like-organism (HLO), acute and chronic inflammatory infiltrate, epithelial cell damage and epithelial cell regeneration. Results: 82% of patients showed infection by HLO. Moreover, this infection reached a frequency of 92.7% in gastric ulcer patients and 94.4% in duodenal ulcer patients. A statistically significant positive correlation was found between HLO infection and polymorphonuclear infiltrate, Iymphocytic infiltrate, mucus depletion and epithelial regenerative activity. There was not a statistical correlation between HLO infection and atrophy. Finally, 90% of patients with multifocal atrophic gastritis and 100% of patients with diffuse antral gastritis had HLO infection. Conclusions: HLO gastric infection frequently caused acute inflammatory changes in gastric mucosa with chronic gastritis. Sometimes these changes were severe, with marked polymorphonuclear migration throughout epithelium and severe epithelial cell damage. Recovery of these changes could be considered as a goal in Helicobacter pylori eradication therapy decision <![CDATA[Neumonía adquirida en la comunidad: Terapia secuencial de cefalosporina intravenosa a cefalosporina oral]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300003&lng=es&nrm=iso&tlng=es Background: Many hospitalized patients with community acquired pneumoniae can be switched early in the course of therapy from intravenous to oral antibiotics, when there are subjective and objective indicators of improvement. This modality of treatment is called "switch therapy". Aim: To compare sequential therapy using an oral third generation cephalosporin, with conventional therapy using intravenous ceftriazone in community acquired pneumonia. Patients and methods: Forty patients admitted due to community acquired pneumonia, initially treated with ceftriazone 1 g/day iv and that showed clinical improvement after three days of therapy, were studied. They were randomly assigned to continue intravenous therapy with ceftriazone for a total of 10 days or switched to ceftibuten 400 mg od for seven days. Results: Twenty one patients continued iv treatment and 19 were switched to ceftibuten. There were no differences between both groups in terms of clinical cure, radiological improvement or normalisation of white blood cell count. Conclusions: Patients with community acquired pneumonia that have a good initial response to intravenous antimicrobials, can be safely switched to oral therapy. This therapy will shorten hospital stay and thereby treatment costs <![CDATA[Anticuerpos anti LKM-1 y crioglobulinemia en hepatitis crónica autoinmune y por virus C de la hepatitis]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300004&lng=es&nrm=iso&tlng=es Background: Anti liver kidney microsome antibodies (LKM-1) have been recently incorporated to the study and classification of chronic autoimmune hepatitis (HC-A1). The presence of anti LKM-1 antibodies and essential cryoglobulinemia is frequent in virus C associated chronic hepatitis (HC-VC). Aim: To study the frequency of anti LKM-1 antibodies and cryoglobulin levels in patients with HC-AI, HC-VC and cryptogenic cirrhosis. Patients and methods: Forty two patients were studied. Nineteen adult women with classic HC-AI with positive antinuclear or anti smooth muscle antibodies. Five patients of less than 20 years old with HC-AI and negative antinuclear and anti smooth muscle antibodies. Ten adult women with cryptogenic cirrhosis, 4 women and 4 men with HC-VC. Serum samples were obtained at 37°C. Antinuclear, anti smooth muscle and anti LKM-1 antibodies were measured by indirect immunofluorescence using Hep-2 cells and rat tissue slices as substrates. Cryoglobulins were determined by the traditional method and cryocrit. Results: All studied patients were anti LKM-1 negative. All had significant circulating cryoglobulin levels. Conclusions: In this sample of patients with HC-AI or HC-VC, anti LKM-1 antibodies were not detected but all had cryoglobulinemia <![CDATA[Prevalencia del asma en escolares chilenos: Estudio descriptivo de 24.470 niños. ISAAC-Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300005&lng=es&nrm=iso&tlng=es Background: There is little information about the prevalence of asthma in Latin American children. Aim: To determine the prevalence of asthma among Chilean school age children. Subjects and methods: The prevalence of respiratory symptoms related to asthma in schoolchildren aged 7 and 13 years, coming from South Santiago, Central Santiago, Valdivia and Punta Arenas, was determined using the methodology of the International Study on Asthma and Allergies in Childhood (ISMC). A random sample of school children aged 6-7 and 13-14 years from each locality was selected. This resulted in 24)470 surveyed children (11,723 aged 6-7 years and 12,747 aged 13-14 years). Results: The current prevalence of wheezing ("wheezing in the last 12 months") ranged from 16.5% to 20.ó% in children aged 67 years, and from 6.8% to 11.7% in children aged 13-14 years. The cumulative prevalence of asthma ("asthma ever"), ranged from 9.7% and 16.5% in the 6-7 years group and from 7.3% to 12.4% in those aged 13-14 years. Conclusions: This study found much higher figures for prevalence of respiratory symptoms related to asthma in school children than those previously reported in this country, with a significant variability between centers (p&lt;0.05). The prevalence of asthma in Chilean schoolchildren is as high and variable as that reported in industrialized countries <![CDATA[Recurrencia familiar de labio leporino con o sin fisura velopalatina de origen no sindrómico en poblaciones de Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300006&lng=es&nrm=iso&tlng=es Background: The presence of major genes in the susceptibility of non syndromic cleft lip with or without cleft palate (CL/P) in Chile has been postulated, considering the high prevalence and familial aggregation of this condition. Aim: To study the familial recurrence of CL/P in Chile. Patients and methods: The recurrence risk of CL/P was studied in 217 extended pedigrees where 33 (15.2%) were multiplex (21 male and 12 female propositi). These multiplex extended pedigrees (with more than one affected individual) represented 75 nuclear pedigrees, constituted by 840 males and 803 females and are the basic information of this study. Results: A significantly higher frequency of affected males (4.15%) than affected females (2.27%) was observed, independent of the difference in number of propositi by sex. Even though no differences were observed between families where both parents were unaffected, compared to those with only one affected parent, a higher proportion of affected descendants was found when the affected propositi was the mother. In multiplex families, the recurrence risk, according to the genetic proximity to the proband, was 10.1, 3.6 and 3.3% respectively for first, second and third degree relatives. The figures were 1.5, 0.5 and 0.4% respectively, when adjusted to the 217 extended pedigrees. Considering that the risk for the general population in Chile is approximately 0.16%, it is 10.3, 3.2 and 2.6 times higher among affected families. Conclusions: The high heritability of CL/P and the risk encountered for the Chilean population supports the hypothesis of major genes involved in its susceptibility <![CDATA[Mejorando la calidad de la enseñanza de entrevista clínica: evaluación de una intervención en estudiantes de medicina]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300007&lng=es&nrm=iso&tlng=es Background: Quality of clinical interview is a key issue both for patient satisfaction and for diagnostic efficiency. Its adequacy relates to better clinical diagnosis treatment plans and patient compliance. Aim: To measure the quality of interviews performed by medical students in three Chilean medical schools before receiving specific training on the subject and to compare the scores obtained after introductory courses on interview. Material and methods: The interviews were videotaped and then evaluated using an objective scale, that measures 33 skills grouped in six areas: opening, problem exploration, non verbal facilitation, interpersonal. patient reaction and closing. The students were assigned to an experimental group that received an interactive workshop with roleplays, vignettes and videotape feedback, and to a non intervention group that received the usual bedside training on medical interviews. Results: Both groups shared the same skill level before the training, with better scores on nonverbal, patient reaction and problem exploration, and worse ones on closing and interpersonal skills. Comparing pre and post-test results, the overall score improved in the experimental group (from 33.2 to 38.3, p=0.002) and worsened among non intervened students. There were statistically significant changes for opening (p&lt; 0.002), problem exploration (p&lt; 0.05), non verbal facilitation (p&lt; 0.0001) and closing (p&lt; 0.0001). Conclusions: It is important to train students not only in specific knowledge contents but in the process of interview. This training should encourage the development of empathy and closing skills <![CDATA[Valor pronóstico del índice de Sharp en la respuesta clínica y de laboratorio a un pulso intravenoso de metilprednisolona en pacientes con artritis reumatoídea]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300008&lng=es&nrm=iso&tlng=es Background: No reliable variables to predict clinical or laboratory response to treatment in patients with rheumatoid arthritis were available until recently. Aim: To asses the potential predictive value of the Sharp’s modified radiographic joint damage index for the assessment of clinical and laboratory response to a methylprednisolone i.v. pulse. Patients and Methods: Twenty-two patients suffering from rheumatoid arthritis received a single i.v. pulse of 1 g of methylprednisolone. Hand X-rays were taken at baseline and blindly scored by two trained radiologists. Clinical and laboratory variables were assessed at baseline and at weekly intervals up to 30 days plus a 60 days final evaluation. Improvement was defined as a 50% amelioration in 4 variables. Results: Assessment of radiographic scores had a high correlation between and within observers (intraclass correlation= 0.998). Sharp score did not reach statistical significance as global predictor for the inflammatory variable response to methylprednisolone. However, when the number of swollen joints was taken into account, patients with a low erosive score (Sharp "d 50) had a more prolonged clinical response, than patients with higher erosive score (Sharp &gt;50) (Fisher test p= 0.023). It is of clinical importance to point out that among patients with high Sharp score there were also responders who reached a high level of improvement. A statistically significant correlation between the basal PCR serum titers and the radiographic score (p&lt; 0.02) was observed. Conclusions: The number of swollen joints and other variables that consider joint structural changes should be considered for the assessment of rheumatoid arthritis patients <![CDATA[Enfrentamiento médico quirúrgico de la invaginación intestinal: Experiencia de una institución universitaria]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300009&lng=es&nrm=iso&tlng=es Background: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. Aim: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. Patients and methods: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. Results: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. Conclusions: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children <![CDATA[Intoxicación aguda con metotrexato usado con fines abortivos: descripción de 2 casos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300010&lng=es&nrm=iso&tlng=es Acute intoxication with methotrexate, used as an abortive, has not been described in Chile. We report two female patients, aged 15 and 24 years old, who presented with mucositis, erythrodermia, pancytopenia, and elevation of hepatic enzymes. Plasma methotrexate levels confirmed the clinical diagnosis and both patients were treated with high leucovorin doses and management of associated complications. In one patient, pregnancy continued, giving birth to a newborn with cranial, face and limb malformations. The second patient had a late rescue with leucovorin and was discharged with a persistent sensory motor neuropathy. Considering the severity of complications and that patients may deny its use, when there is reasonable clinical suspicion of methotrexate intoxication, leucovorin treatment should be started <![CDATA[Mucocele intracraneal: Comunicación de un caso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300011&lng=es&nrm=iso&tlng=es Mucocele, usually associated to paranasal sinuses is defined as an abnormal accumulation and retention of mucous secretions. It usually presents with intraorbital or paranasal and rarely with pure neurological symptoms. We report a 41 years old male who presented with a history of supraorbital left headache, diplopia and proptosis. CT scans and magnetic resonance imaging showed an expansive mass in the right frontal sinus. The patient was operated, the presumptive preoperative clinical diagnosis of mucocele was confirmed and the lesion was drained. A postoperative CT scan confirmed the normal expansion of the frontal lobe <![CDATA[Cuerpo extraño vegetal en la vía aerea: una causa poco frecuente de hemoptisis en la niñez. Caso clínico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300012&lng=es&nrm=iso&tlng=es Hemoptysis is an infrequent symptom in childhood and potentially life threatening. The most common causes in this age group are bronchiectasis secondary to cystic fibrosis, cardiovascular and pulmonary congenital anomalies and a miscelaneous group of causes including retained intrabronchial aspirated foreign bodies. We report a previously healthy 5-year-old girl with recurrent pneumonias associated with episodes of hemoptysis. She was admitted in our institution to investigate the persistence of hemoptysis. Based on clinical history, aspiration of a vegetal foreign body was postulated as the etiology and it was confirmed in the pathological examination after surgical exploration, with pulmonary lobe resection. The importance of a good history taking in pediatric hemoptysis is emphatized <![CDATA[¿Es la diabetes del adulto tipo-2 una variedad de la diabetes idiohipofisiaria?: Una proposición]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300013&lng=es&nrm=iso&tlng=es The advances in the study of the role of growth hormone (GH) in the field of diabetes, confining clinically its glucoregulatory and diabetogenic effects, plus relevant findings in basic research, open new perspectives. The influence of GH on Type-2 diabetes is based on the classic experiments of Houssay’s school, the diabetogenic action of GH and its transferrin mediator. Since GH is under hypothalamic command, the permanent GH hypersecretion is the pathophysiological evidence for hypothalamic dysfunction. Thus, type-2 diabetes is postulated as a reversible type of clinical idiohypohyseal diabetes. Different degrees of hypophyseal diabetes can be observed, with the interplay between insulin-growth factor-l and transferrin in some cases of acromegaly. In cases of selective predominance of GH and the consequent chronic elevation of transferrin levels, idiohypophyseal diabetes would develop. Therefore, this type of diabetes should be treated with hypothalamic GH inhibitors. In this line of thinking, the use of somatostatin analogs looks promising <![CDATA[Asma bronquial y enfermedades atópicas como problema emergente de Salud Pública: nuevas hipótesis etiológicas. La experiencia de sociedades desarrolladas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300014&lng=es&nrm=iso&tlng=es Developed countries report increasing trends in the prevalence of asthma and atopic diseases over the last 40 years. This change cannot be attributed to artefactual effects. Emerging from these information, new approaches have been generated to explore these novel findings. Among the most important new factors to be explored, scientific research is pointing out to variables related with physical environment, socio-economic and genetic background, anthrophometry at birth, nutritional status, diet, exercise and hormonal profile. Changes in the epidemiology of asthma and atopic conditions in developed countries were also preceded by increases in the prevalence of chronic diseases and their risk factors. Chile does not have information about time trends on these diseases, but several studies are reporting a high prevalence of asthma among adults. Conversely, results from the collaborative ISAAC study carried out in children, have shown a relative low prevalence of asthma in Chilean children. An increasing trend in chronic diseases and their risk factors has been reported in Chile, suggesting an epidemiological pattern similar to that experienced by industrialised countries, when the prevalence of asthma and atopic began to increase. This article review current information about etiological research emphasising the need to develop local research on asthma and atopic diseases taking into account our epidemiological situation <![CDATA[Hipertensión arterial en pueblos aborígenes de Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300015&lng=es&nrm=iso&tlng=es Developed countries report increasing trends in the prevalence of asthma and atopic diseases over the last 40 years. This change cannot be attributed to artefactual effects. Emerging from these information, new approaches have been generated to explore these novel findings. Among the most important new factors to be explored, scientific research is pointing out to variables related with physical environment, socio-economic and genetic background, anthrophometry at birth, nutritional status, diet, exercise and hormonal profile. Changes in the epidemiology of asthma and atopic conditions in developed countries were also preceded by increases in the prevalence of chronic diseases and their risk factors. Chile does not have information about time trends on these diseases, but several studies are reporting a high prevalence of asthma among adults. Conversely, results from the collaborative ISAAC study carried out in children, have shown a relative low prevalence of asthma in Chilean children. An increasing trend in chronic diseases and their risk factors has been reported in Chile, suggesting an epidemiological pattern similar to that experienced by industrialised countries, when the prevalence of asthma and atopic began to increase. This article review current information about etiological research emphasising the need to develop local research on asthma and atopic diseases taking into account our epidemiological situation http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300016&lng=es&nrm=iso&tlng=es http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300017&lng=es&nrm=iso&tlng=es http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000300018&lng=es&nrm=iso&tlng=es