Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720000006&lang=es vol. 128 num. 6 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Educación sexual de niños y adolescentes]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600001&lng=es&nrm=iso&tlng=es There is a remarkable ignorance about sexuality among Chilean teenagers, as underscored by the paper by Fernández et al, published in this issue. The authors analyze the biological, psychological and social consequences of the lack of parental and school sexual education. Among them, there is an increasing incidence of unwanted pregnancies, abortions and sexually transmitted diseases in teenagers. Child abuse, neglect, battering, mortality and maternal deprivation are more frequent among the offspring of teenage parents. School desertion caused by unwanted pregnancies will seriously jeopardize the education and training of these teenagers, perpetuating the cycle of poverty. (Rev Méd Chile 2000; 128: 571-3). <![CDATA[Creencias, actitudes y conocimientos en educación sexual]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600002&lng=es&nrm=iso&tlng=es Background: Previous reports show that Chilean teenagers have an inadequate knowledge about sexuality and reproduction. Aim: To compare the knowlege about sexuality among adolescents coming from private and public schools, with and without sexual education programs. Material and methods: A structured anonymous inquiry, containing multiple choice and open questions, was applied to a sample of 229 adolescents attending seventh and eigth grade of junior school, in private and public schools of Temuco, Chile. Results: Eleven percent of adolescents had already their first sexual intercourse at a mean age of 12.2 ± 2.4 years old. Of these, 96% came from public schools. An overall analysis of tests, disclosed a 53% of correct answers to the inquiry. Adolescents coming from private schools had a better performance than those coming from public schools. Sexual attitudes were not influenced by sexual education programs. Conclusions: Adolescents coming from private schools have a better sexual knowledge level and more conservative attitudes towards sexuality. Overall knowledge is inadequate albeit overvalued. These teenagers are high risk group for unwanted pregnancies and sexually transmitted diseases and require efficient sexual education programs. (Rev Méd Chile 2000; 128: 574-83). <![CDATA[Incremento de la actividad metaloproteinásica y de sus inhibidores en el líquido cefalorraquídeo, en pacientes con paraparesia espástica tropical]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600003&lng=es&nrm=iso&tlng=es Background: Proteolytic modifications of neuronal surfaces and the surrounding extracellular matrix are very important in neuronal development and regeneration. Increased activity of matrix metalloproteinases (MMPs) and their tissue inhibitors, due to secretion by macrophages and lymphocytes, occur in inflammatory processes that disrupt the blood brain barrier. However, neurons and microglia can also secrete these enzymes. Aim: To identify the type of MMP present in the cerebrospinal fluid (CSF) and changes in the expression of tissue inhibitors of metalloproteinases (TIMPs) in patients with HTLV-1 associated tropical spastic paraparesis. Patients and methods: CSF samples from 12 patients with HTLV-1 associated tropical spastic paraparesis and 12 healthy controls were obtained by an atraumatic lumbar puncture. The presence of MMPs was measured by zymography and the relative amounts of TIMPs were measured by immunowestern blot. Results: In the CSF of both controls and patients, a similar gelatinolytic band corresponding to proMMP-2 (latent form) was observed. In 83.3% of patients with HTLV 1 associated tropical spastic paraparesis, the MMP-9 was also present. TIMP-1, TIMP-2 and TIMP-3 were elevated 2.24 ± 0.72, 3.85 ± 1.38 and 5.89 ± 3.4 fold, respectively, in the CSF of patients as compared to controls. Conclusions: Patients with HTLV-1 associated tropical spastic paraparesis have elevated activity of MMP-9 and levels of TIMPs in the CSF, when compared to healthy controls. (Rev Méd Chile 2000; 128: 585-92). <![CDATA[Composición genética de la población chilena: las comunidades urales de los valles de Elqui, Limarí y Choapa]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600004&lng=es&nrm=iso&tlng=es Background: The population that inhabits the semiarid Northern zone of Chile arose from ethnic admixture between aborigines, Spanish conquerors and the influx, during the XVII century, of foreign aboriginal workers and a minority of African slaves. Aim: To study the phenotypic frequencies of 15 genetic markers among populations inhabiting valleys in the Northern zone of Chile and to estimate the percentage of indigenous, African and Caucasian admixture in these populations. Material and methods: Throughout five different field works, blood samples were obtained from 120 individuals living in the Elqui valley, 120 individuals living in the Limari valley and 85 living in the Choapa valley. Blood groups, erythrocyte enzymes, plasma proteins and HLA markers were typified. Results: In the populations studied, the contribution of non indigenous genes was low in relation with the time elapsed since the Spanish invasion. The Hardy-Weinberg disequilibrium for MNS system would have microevolutive implications. The admixture percentages in these valleys confirm ethnic and historic information. The variation of the enzyme esterase D is identical to that of other Chilean populations. Conclusions: The phenotypic and genetic frequencies in the three populations studied and different admixture of indigenous genes is inversely proportional to the geographic distance from Santiago, in Central Chile. (Rev Méd Chile 2000; 128: 593-600). <![CDATA[Apendicitis epiploica primaria: diagnóstico clínico y radiológico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600005&lng=es&nrm=iso&tlng=es Background: Torsion of appendices epiplocae leads to an ischemic infarct of surrounding adipose tissue, causing a syndrome, called "primary epiploic appendagitis" characterized by acute abdominal pain that can simulate a surgical clinical picture. Aim: To describe the clinical picture, ultrasonographic and computed tomographic features of primary epiploic appendagitis. Material and methods: A report of patients with acute abdominal pain whose diagnosis was a primary epiploic appendagitis, diagnosed and treated in a period of 48 months. Results: fifty five patients (45 males) aged 16 to 76 years old are reported. Their clinical presentation was acute abdominal pain in the left abdominal quadrant in 48, pain in the right lower quadrant in 4 and epigastric pain in two. Two had mild fever and 12 had nausea. Ten perform physical activities prior to the onset of pain. Imaging examinations showed a 1.5 to 5 cm diameter, uncompressible small mass of adipose origin, located anteriorly and anterolaterally, between the colon and the abdominal wall. There were inflammatory phenomena surrounding the lesion and thickening of the neighboring parietal peritoneum. In all cases, the mass gradually subsided with medical treatment. Conclusions: Primary epiploic appendagitis is a relatively frequent cause of spontaneously resolving abdominal pain. It is diagnosed by ultrasound or CT scanning. (Rev Méd Chile 2000; 128: 601-7). <![CDATA[Tratamiento con radioyodo del bocio difuso hipertiroideo: influencia del pretratamiento con propiltiuracilo]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600006&lng=es&nrm=iso&tlng=es Background: To stabilize Graves disease and deplete the preformed hormone, the use of antithyroid drugs prior 131I therapy has been suggested, specially in those patients with severe thyrotoxicosis and in the elderly. However, PTU may reduce the effectiveness of 131I. Aim: To study the effects of PTU pretreatment before 131I administration. Subjets and methods: A retrospective analysis of the medical records of patients with Graves disease treated with 131I from 1989 to 1997 was made. Of 244 patients with adequate follow-up for at least 12 months after 131I treatment, 142 had not been pretreated and 102 had received PTU prior to 131I therapy. Pretreated patients were distributed according to the number of days that PTU was discontinued before reciving 131I, forming four groups (a=5d, b=6-14 d, c=15-30 d and d=31-60 d). Radioiodine was delivered according to our protocol of 120 µCi per gram of thyroid tissue, as estimated by clinical examination. Therapy was considered successful when laboratory evidence of euthyroidism or hypothyroidism after one year of treatment was obtained and as a failure when undetectable TSH values persisted after 12 months of treatment with 131I. Results: All groups were comparable as to age, gender, goiter size, and 24 h radioiodine uptake. Control of hyperthyroidism was achieved in 76% of the non pretreated group. A similar percentage was observed in groups (b), (c) and (d). However, the disease was controlled in only 50% of group (a) patients (p <0.003). Conclusions: The therapeutic efficacy of 131I is significantly reduced when the PTU is stopped for only a few days prior to the use of radioiodine. We postulate that PTU has to be discontinued for at least 10 days before radioiodine administration. (Rev Méd Chile 2000; 128: 609-12). <![CDATA[Comparación psicométrica transcultural de la depresión mayor entre Chile y Alemania]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600007&lng=es&nrm=iso&tlng=es Background: Depressive symptoms and personality features of patients with mood disorders are supposed to have a strong variability in cross cultural studies. The clinical profile, the outcome and the treatment response seem to be different across the world. Aim: To investigate the differences and similarities of major depressive disorders in Chile and Germany. Material and methods: Sixty seven Chilean and German depressive inpatients, without comorbidity on axis I or II were studied. Diagnosis of depression was based on DSM IV and ICD 10 criteria for major depression. Symptomatology was assessed using the self reporting questionnaire (SRQ-20), the Symptom checklist-90-revisited (SCL 90-R), the Beck inventory for Depression (BDI), and the Hamilton scale for depression (HAM-D). Personality was assessed with the Munich Personality Scale. Results: Only the SRQ-20 shows significantly higher tendency towards depression among Chilean patients. At the personality level, Chileans exhibited higher scores in extroversion, neuroticism, esoteric and isolating tendencies. Conclusions: These results help to understand differences and similarities between depressive syndromes across cultures. They suggest that the relation between symptomatology, some personality traits and severe major depression has little variability across cultures. (Rev Méd Chile 2000; 128: 613-8). <![CDATA[Maniobra de reposición canalítica para el tratamiento del vértigo postural paroxístico benigno]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600008&lng=es&nrm=iso&tlng=es Background: Paroxysmal positional vertigo is a frequent and handicapping disease. Aim: To assess the effectiveness of physical therapies using particle reposition procedures in the treatment of paroxysmal positional vertigo. Patients and methods: Fifty nine patients (13 male) with paroxysmal positional vertigo were studied. Clinical data was gathered, the affected channel was identified. In the same session, the corresponding canalith reposition procedure was performed (Epley maneuver for posterior channel and Lempert maneuver for lateral channel) and the immediate response was recorded. Results: Twenty seven percent of patients had recurring episodes of vertigo and 60% had more than two weeks of evolution. In 49% of patients, vertigo was considered idiopathic and in 92%, the posterior channel was affected. One patient had a combined lesion of posterior and lateral channels and two patients had isolated lateral channel lesions. Seventy percent of patients recovered after two sessions of canalith reposition procedure. Conclusions: Canalith reposition maneuvers were highly effective for the treatment of paroxysmal positional vertigo. (Rev Méd Chile 2000; 128: 619-26). <![CDATA[Factores de riesgo de fallecer en domicilio por neumonía, de niños chilenos de estratos socioeconómicos bajos, Santiago de Chile (1990-1994)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600009&lng=es&nrm=iso&tlng=es Background: Pneumonia is the main cause of late infant mortality in Chile. Over 60% of these deaths occur at home. The lack of hospital beds and the inadequate outpatient management are contributing factors. Aim: To assess risk factors for home deaths due to pneumonia in Chilean children. Patients and methods: The clinical and environmental histories of 53 (39 male) children that died due to pneumonia in their homes were analyzed. The cause of death was confirmed by necropsy with histopathological studies in all cases. These cases were compared with 88 control children of similar age, gender, socioeconomic status and living in the same geographical area of Metropolitan Santiago. Results: Fifty four percent of deceased children were of less than 3 months of age and only 3 cases and their controls were above1 year old. Identified risk factors for death were malnutrition with an odds ratio of 30.6 (CI 3.9-64.8, p< 0.001), low birth weight with an odds ratio of 5 (CI 1.8-14.1, p< 0.001), previous admissions to hospitals with an odds ratio of 5.79 (CI 2-17.1, p< 0.001), congenital malformations (mainly cardiac) with an odds ratio of 8.4 (CI 2-39.9, p= 0.001) and a history of bronchial obstruction with an odds ratio of 5.68 (p< 0.001). Identified maternal risk factors were smoking with an odds ratio of 4.13 (CI 1.6-10.7 p< 0.001) and being a teenager with an odds ratio of 4.3 (CI 1.7-11, p<0.001). Malnutrition, low birth weight, history of previous hospital admissions and having a teenager or smoker mother were considered as independent risk factors using a stepwise analysis. Conclusions: Chilean low income children have identifiable risk factors for death at their homes due to pneumonia, that can be preventively managed. (Rev Méd Chile 2000; 128: 627-32) <![CDATA[Bronquiolitis obliterante con neumonía en organización secundaria a quimioterapia, en un niño con sarcoma pericárdico primario]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600010&lng=es&nrm=iso&tlng=es The uncommon bronchiolitis obliterans organizing pneumonia can be idiopathic or caused by infection or medications. We report a 5 year old boy with pericardial sarcoma that was treated with chemotherapy (vincristine, doxorubicin, etoposide, cyclophosphamide) and radiotherapy. During the third cycle of chemotherapy, he developed progressive cough and dyspnea, needing oxygen therapy. Chest X-ray examination showed bilteral infiltrates. After discarding infectious etiologies, an open lung biopsy was performed, and the pathological examination showed a bronchiolitis obliterans organizing pneumonia. He was treated with prednisolone for 7 days, followed by prednisone for additional 45 days. He continued with fluticasone propionate as maintenance and remains in good condition with a ches X ray showing mild interstitial images, after seven months of follow up. (Rev Méd Chile 2000; 128: 633-40). <![CDATA[Hialohifomicosis invasiva hepatoesplénica.: Comunicación de un caso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600011&lng=es&nrm=iso&tlng=es Invasive fungal infections are an increasingly common problem in patients with cancer and other vulnerable groups. We report a case of hepatosplenic hialohifomycosis probably by Aspergillus sp. In a patient with acute leukemia, and prolonged neutropenia, treated with corticosteroids and broad spectrum antibiotics. A review concerning diagnosis, clinical course and treatment of this condition is presented. (Rev Méd Chile 2000; 128: 641-6). <![CDATA[Síndrome hemorragíparo por exposición a raticida.: Comunicación de un caso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600012&lng=es&nrm=iso&tlng=es We report a 22 years old male, admitted to the emergency room due to a life threatening coagulation disorder, with prothrombin times fluctuation between 5 and 37% and very low activity of factors II, VII, IX and X. In the month prior to the admission, the patient had used the rodenticide difethialone, without any precaution to avoid accidental exposure. The patient was maintained with fresh frozen plasma until oral vitamin K1 was obtained. This medication corrected the coagulation disorder. (Rev Méd Chile 2000; 128: 647-9). <![CDATA[La inmunología clínica actual: una perspectiva genética y molecular]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600013&lng=es&nrm=iso&tlng=es During the last few decades, basic scientists and clinicians have gained a deeper insight of the cellular and molecular physiology of the immune system. The widespread application of molecular biology and genetic techniques has advanced our understanding of states of health and disease, bringing forth renewed hopes concerning the advent of a more "specific" therapeutic era of clinical immunology. The precise structural and genetic characterization of molecular complexes such as B and T-cell receptors, the Major Histocompatibility Complex (MHC), cytokines, chemokines, cellular receptors and co-receptors has produced a wealth of information open to both diagnostic and therapeutic purposes. We herein review several recent advances in the molecular and genetic characterization of immune deficiency states, autoimmunity and the induction of antigen specific immune unresponsiveness or tolerance, together with the therapeutic implications of these findings. (Rev Méd Chile 2000; 128: 650-8). <![CDATA[Disfunción endotelial como alteración primaria en las patologías vasculares]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600014&lng=es&nrm=iso&tlng=es Endothelium controls vascular smooth muscle tone by secreting relaxing and contracting factors. There is a constant release of endothelium derived relaxing factors, mainly nitric oxide, a potent vasodilator, inhibitor of platelet aggregation, monocyte adhesion and smooth muscle proliferation. In addition, the endothelium may increase the release of NO in response to humoral stimulation by vasoactive substances such as acetylcholine, bradikinin or substance P. Although the endothelium releases a number of products, no single blood test has yet proved useful to determine normal endothelial function or as early abnormalities. The most useful test of endothelial function relies on the meassurement of endothelium-dependent dilatation in response to pharmacological or physiologic stimuli. The alteration of this response is known as endothelial dysfunction and has been observed in a variety of circumstances related to cardiovascular risk. This review summarizes the evidence that sustains this association and emphasizes the clinical utility of assessing endothelial function presenting two clinical cases of hypercholesterolemia in which a high-resolution vascular ultrasound in the braquial artery was used. (Rev Méd Chile 2000; 128: 659-70). <![CDATA[Desempeño académico de los estudiantes de medicina: ¿Un resultado predecible?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600015&lng=es&nrm=iso&tlng=es Aceptado en versión corrBackground: Traditionally, medical schools demand their students a high dedication in time, responsibility and integrity. Aim: To assess the predictive capacity of several specific variables, on the academic performance of medical students. Material and methods: All students who entered during 1984-1995 period were studied. The academeic performance was assessed using two indices: an overall evaluation of successfulness as determined by the approval rate in different courses and grade-point average obtained during the first three years at the Medical School. The variables used to predict academic performance were year of enrollment, high school grades, university admission test scores, biomedical and demographic characteristics. All these were meassured at the time when the student was enrolled. Results: Eight hundred and eight students were studied at the end of the third year. The most important predictive variables selected for both performance indices were: high school grades, admission biology test scores, place were high school studies were done, and previous university studies. In addition verbal and mathematics admission academic performance tests scores were selected for grade-point average index. Although, the overall admission score and high school academic performance were significantly associated with the two outcomes, they were not selected in the final models. Conclusions: The best predictors of an optimal academic performance in these medical students were high school grades, admission bilogy test scores, residing in Metropolitan Santiago and previous university studies. (Rev Méd Chile 2000; 128: 671-8). <![CDATA[Normas bioéticas de UNESCO para evitar prácticas eugenésicas en investigaciones biomédicas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600016&lng=es&nrm=iso&tlng=es The author, member of the UNESCO Bioethics Committee, participated in the preparation of the Universal Declaration about Human Genoma and Human Rights, in 1997. The aim of this work is to analyze the initial articles of such Declaration, defining the bioethical principles that defend human dignity, freedom and rights, against the madness of the present biotechnological revolution. The development of genetics for the benefit of mankind will be guaranteed if these principles are honored. Genetic discrimination, reductionism and determinism, are identified by the author as perversions that, if used by biotechnologists, can lead to the rebirth of eugenism and racism, that were condemned by the Code of Nuremberg, in 1947. Investigators must assume their responsibility, respecting the principles of human dignity, the real freedom of research and solidarity among people. This attitude will avoid the use of genetics for purposes other than the welfare of mankind. (Rev Méd Chile 2000; 128: 679-82). <![CDATA[Implementación de un laboratorio de biología molecular y estandarización de metodología inmunológica en el Hospital Clínico Regional de Valdivia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600017&lng=es&nrm=iso&tlng=es The author, member of the UNESCO Bioethics Committee, participated in the preparation of the Universal Declaration about Human Genoma and Human Rights, in 1997. The aim of this work is to analyze the initial articles of such Declaration, defining the bioethical principles that defend human dignity, freedom and rights, against the madness of the present biotechnological revolution. The development of genetics for the benefit of mankind will be guaranteed if these principles are honored. Genetic discrimination, reductionism and determinism, are identified by the author as perversions that, if used by biotechnologists, can lead to the rebirth of eugenism and racism, that were condemned by the Code of Nuremberg, in 1947. Investigators must assume their responsibility, respecting the principles of human dignity, the real freedom of research and solidarity among people. This attitude will avoid the use of genetics for purposes other than the welfare of mankind. (Rev Méd Chile 2000; 128: 679-82). <![CDATA[Enterococcus faecium resistente a vancomicina]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600018&lng=es&nrm=iso&tlng=es The author, member of the UNESCO Bioethics Committee, participated in the preparation of the Universal Declaration about Human Genoma and Human Rights, in 1997. The aim of this work is to analyze the initial articles of such Declaration, defining the bioethical principles that defend human dignity, freedom and rights, against the madness of the present biotechnological revolution. The development of genetics for the benefit of mankind will be guaranteed if these principles are honored. Genetic discrimination, reductionism and determinism, are identified by the author as perversions that, if used by biotechnologists, can lead to the rebirth of eugenism and racism, that were condemned by the Code of Nuremberg, in 1947. Investigators must assume their responsibility, respecting the principles of human dignity, the real freedom of research and solidarity among people. This attitude will avoid the use of genetics for purposes other than the welfare of mankind. (Rev Méd Chile 2000; 128: 679-82). http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600019&lng=es&nrm=iso&tlng=es http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600020&lng=es&nrm=iso&tlng=es http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000600021&lng=es&nrm=iso&tlng=es