Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720020002&lang=es vol. 130 num. 2 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Composición genética de la población chilena: Distribución de polimorfismos de DNA mitocondrial en grupos originarios y en la población mixta de Santiago]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200001&lng=es&nrm=iso&tlng=es Background: The analysis of mitochondrial DNA restriction site polymorphisms assigns most Latin American aborigines to four haplogroups. These are characterized by determined polymorphic restriction sites and a deletion of 9 base pairs in the intergenic region V. Aim: To study the distribution of mitochondrial DNA haplogroups in Chilean aboriginal groups, as well as in the mixed population of Santiago. Material and methods: One hundred twenty Aymara subjects and 23 Atacameño subjects from the Northern part of Chile and 162 randomly chosen subjects residing in Santiago were studied. DNA was extracted from peripheral lymphocytes. Mitochondrial DNA was amplified by means of polymerase chain reaction. Results: The frequency of haplogroup B decreases from north to south. Aymaras in the north have the highest frequency (64%) and it is absent among the Yamanas (previously studied) in the extreme South. Haplogroups C and D show an inverse tendency. It is noteworthy that 84% of mitochondrial haplogroups of the mixed population of Santiago are of Amerindian origin whereas the Y-chromosomes are mainly European. Conclusions: The peculiar distribution of haplotypes indicate that the population of Santiago is the result of an asymmetric mating system in which the females ancestors were mainly Amerindian and the male ancestors mainly European (Rev Méd Chile 2002; 130: 125-31) <![CDATA[Experiencia de 36 años con marcapasos implantables: Un análisis histórico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200002&lng=es&nrm=iso&tlng=es Background: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes. Aim: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998. Material and methods: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificación de Chile (Chilean Civil and Identification Registry). Results: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74% from 1988 to 1998. Complication rate was 42% in the 1963-1976 study period, it decreased to 10.6% in the 1977-1987 study period, and to 5.6% by 1988-1998. Only two patients died during surgery in the study period (0.08%). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52% at ten years, 33% at 15 years, and 21% at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old. Conclusions: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures (Rev Méd Chile 2002; 130: 132-42) <![CDATA[Los genotipos de <I>Helicobacter pylori</I> en gastritis no atrófica difieren de los encontrados en úlcera péptica, lesiones premalignas y cáncer gástrico en Colombia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200003&lng=es&nrm=iso&tlng=es Background: Helicobacter pylori is recognized as an etiologic agent of several gastric diseases. Bacterial genotypes have been related to clinical outcome in several populations. Aim: To compare cagA, vacA and iceA genotypes of Colombian isolates from patients with several gastrointestinal diseases, including gastric cancer. Material and methods: We used polymerase chain reactions to amplify vacA, cagA and iceA genes of 137 H pylori isolates coming from 26 patients with gastric cancer (GC), 34 with peptic ulcer (PU), 19 with intestinal metaplasia (IM), 23 with atrophic gastritis (AG) and 35 with non atrophic gastritis (NAG). Results: vacA s1-m1, cagA+, iceA+ were the most frequently found genotypes. vacA s1 and m1 subtypes were found in 92 (67%) and 82 (60%) cases respectively. Sixty three percent were cagA+ and 85% were iceA+. There was a lower prevalence of s1 allele in cases of NAG (43%), compared with GC, PU and IM (81%, 77% and 81% prevalence, respectively, p <0.01). Isolates from NAG also showed a low frequency of vacA m1 subtype (40%) compared with GC or IM (81% and 84% respectively, p <0.01). The prevalence of cagA+ strains was significantly higher in GC patients (80%) than in NAG patients (51.4%, p <0.01). No differences in the frequency of vacA s1a, s1b and iceA subtypes, were observed. Conclusions: A lower frequency of cytotoxic H pylori genotypes such as cagA and vacA s1m1 and a higher frequency of non cytotoxic genotypes, was observed in patients with NAG, when compared to patients with GC or PU. These results suggest that even in Colombia, vacA and cagA could be used as markers of increased virulence (Rev Méd Chile 2002; 130: 143-51) <![CDATA[Efectos de la erradicación de <I>Helicobacter pylori</I> sobre el reflujo gastroesofágico patológico en pacientes con úlcera duodenal]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200004&lng=es&nrm=iso&tlng=es Background: Helicobacter pylori infection is not a risk factor for gastroesophageal reflux disease and it could even be a protector factor. Aim: To study the relationship between H pylori eradication and gastroesophageal reflux symptoms in patients with duodenal ulcer. Patients and methods: One hundred eleven patients with duodenal ulcer and treated for H pylori infection were studied. In 96 patients, H pylori was successfully eradicated and were evaluated every four months with endoscopy, during the first year. Thereafter, an annual clinical assessment was performed and endoscopy was repeated only if clinically indicated. Results: Patient were followed for a mean of 41 months (range 4 months to 6 years). Twelve patients (10.8%) had esophagitis at recruitment and in nine, H pylori was eradicated. The frecuency of gastroesophageal reflux symptoms or esophagitis in this group was similar to the rest of patients. During the first year, the frecuency of reflux symptoms ranged from 9 to 19%. The frecuency of esophagitis persisted at about 10%, although 81% of patients with esophagitis did not have it on recruitment. After the first year, the frecuency of reflux symptoms declined significantly to about 8%. Conclusions: In these patients with duodenal ulcer, gastroesophageal reflux disease had a variable evolution after H pylori eradication (Rev Méd Chile 2002; 130: 153-9) <![CDATA[Prevalencia de síntomas habitualmente asociados a la hipertensión arterial en población normotensa e hipertensa]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200005&lng=es&nrm=iso&tlng=es Background: High blood pressure should be symptomless. However, popular knowledge attributes some symptoms such as headache, epistaxis or dizziness to high blood pressure. Aim: To compare the prevalence of headache, epistaxis, subconjunctival hemorrhages and dizziness in people with normal or high blood pressure. Subjects and methods: A representative sample of an urban population in Chile was studied. Each subject with high blood pressure was paired with a non-related individual of the same sex and age. These subjects were interrogated about the presence of symptoms. Results: One thousand forty eight subjects with high blood pressure (481 male) and 1052 individuals with normal pressure (483 male), were studied. In subjects with high or normal blood pressure, the prevalence of headache was 22 and 21.8% respectively, epistaxis was 11.6 and 11% respectively, dizziness was 7.4 and 7.6% respectively, tinnitus was 9.1 and 9.4% respectively and subconjunctival hemorrhage was 2.9 and 3.1% respectively (p = NS). Conclusions: No differences in the prevalence of symptoms, popularly attributed to hypertension, were observed between subjects with normal or high blood pressure (Rev Méd Chile 2002; 130: 160-6) <![CDATA[Anticuerpos anti-tiroglobulina en el seguimiento de pacientes con cáncer diferenciado de tiroides: ¿Marcadores de enfermedad residual o recidivante?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200006&lng=es&nrm=iso&tlng=es Background: Anti thyroglobulin antibodies are present in 25% of patients treated for a differentiated thyroid cancer, invalidating thyroglobulin determination. Those patients subjected to total thyroidectomy and free of disease, should reduce the production of these antibodies, due to the lack of antigenic stimulus. Therefore, anti thyroglobulin antibodies could be useful to detect early relapses. Aim: To assess the relationship between anti thyroglobulin antibodies and the evolution of the disease in patients treated for thyroid cancer. Material and methods: Retrospective analysis of 26 patients treated for thyroid cancer with positive anti thyroglobulin antibodies, followed for three years. These were divided in those with or without lymphocytic thyroiditis (19 and 7 respectively). Results: At the first year of follow up, anti thyroglobulin antibody concentration was 401±94.9 UI/ml (x±sem) in patients with thyroiditis and 38.9±8.9 UI/ml in those without thyroiditis (p < 0.005). During the three years of follow up, no differences in anti thyroglobulin antibodies were observed between patients with or without tumor relapse. Conclusions: Concentration of anti thyroglobulin antibodies was higher in patients with thyroiditis and did not differentiate patients with tumor relapse (Rev Méd Chile 2002; 130: 167-72) <![CDATA[Ecotomografía Doppler arterial intrarrenal en pacientes cirróticos con ascitis, con y sin síndrome hepatorrenal]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200007&lng=es&nrm=iso&tlng=es Background: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS. Aims: to assess the RI in cirrhotic patients with ascites, with and without HRS. Patients and methods: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70. Results: The RI values, mean and SD) were: normal subjects: 0.58 ± 0.05, cirrhotics with ascites: 0.65 ± 0.05 and cirrhotics with ascites and HRS: 0.78 ± 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI ≥ 0.70 were 3.32 (CI 95% = 1.79 - 6.2) Conclusions: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded (Rev Méd Chile 2002; 130: 173-80) <![CDATA[Asignación de recursos en salud en Chile: Consideraciones éticas en la toma de decisión]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200008&lng=es&nrm=iso&tlng=es Background: The inclusion of ethical aspects in the world health care reform is currently being discussed. Aim: To analyze the ethical component of health care decision making in Chile. Material and methods: A qualitative analysis of interviews with 4 health service directors, 4 public hospital directors and 1 sub director. Inquiries to 16 public hospital ethics committees, about importance of ethical components in decision making, role of ethics committees in financial issues and the feasibility of incorporation explicit ethical considerations in decision making. Results: There is an absence of explicit ethical criteria in decision making. There is little participation of directors in these issues and lack of information. Although ethical aspects are considered relevant, they are not taken into account. Ethics committees are mostly dedicated to evaluate research protocols. The community is not mentioned as a relevant actor in decision making about resource allocation. Conclusions: Health service directors and all health care personnel should be trained in bioethics. These aspects should be incorporated to their daily work (Rev Méd Chile 2002; 130: 181-190) <![CDATA[Estudio neuroepidemiológico en Aratoca, una área rural del oriente colombiano]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200009&lng=es&nrm=iso&tlng=es Background: Current health statistics on the prevalence of neurological diseases, in Colombia, are still lacking. Aim: To determine the prevalence of migraine, cerebrovascular disease, movement disorders, peripheral neuropathies, mental retardation and developmental disorders, epilepsy, dementia and sequels of cranial trauma in a rural population of Colombia. Materials and methods: We evaluated 544 subjects in Aratoca, a rural place of Santander, placed at 400 kilometers from Bogota. The world health organization (WHO) protocol for neuroepidemiological studies modified by our group, a survey to determine sequels of cranial trauma and the mini mental state examination were used as instruments. People 12 years-old or more and suspected to have a neurological disease was evaluated by adult neurologists and those less than 12 years-old were evaluated by a neuropediatrician. Results: 223 out of 544 subjects surveyed were evaluated by the clinicians of which 135 had a neurological disorder. The prevalence of neurological diseases, per thousand inhabitants were as follows: migraine 189.3; epilepsy 33; febrile seizures 25.6; peripheral neuropathy 22.1; mental retardation 18.4; developmental and language disorders 11; dementia 10.5; cerebrovascular disease 4.7; and movement disorders 3.7. Conclusions: These results will allow to define appropriate control measures, as well as to prevent and treat these prevalent neurological disorders in rural places of Colombia as Aratoca and the like (Rev Méd Chile 2002; 130: 191-9) <![CDATA[Hipertensión pulmonar y embarazo]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200010&lng=es&nrm=iso&tlng=es A 36 year old woman, with an 18 year history of syncope, became pregnant shortly after a cardiac catheterization demonstrated a high pulmonary arterial pressure and resistance and a low cardiac output. During pregnancy she remained stable at NYHA FC III, on nifedipine, apresoline, isosorbide, aspirin and bed rest. At 28 weeks, catheterization showed a decreased pulmonary pressure and an increased cardiac output. At 38 weeks, she was submitted to an elective caesarean section, and delivered a healthy newborn of 2820 g. After 5 months, her catheterization showed a pulmonary artery pressure similar to the pre-pregnancy study. Her condition deteriorated, leading to death 10 months later. Urinary 6-keto-PGF1∂, nitrates/nitrites, kallikrein and angiotensin-(1-7) were increased from 13 to 33 weeks, to drop in week 35 of pregnancy. The safe maternal and fetal outcome, and the intragestational hemodynamic improvement are attributed to a close multidisciplinary surveillance, and to the effects of the endogenous vasodilators of pregnancy on the reversible component of the pulmonary hypertension. Reports in the literature show a decrease in maternal mortality rate, from 56% for the period previous to 1963, to 34 and 30% for those spanning between 1978-1996 y 1997-2001 respectively (Rev Méd Chile 2002; 130: 201-8) <![CDATA[Fascitis eosinofílica: experiencia en tres casos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200011&lng=es&nrm=iso&tlng=es Eosinophilic fasciitis (EF) is a scleroderma-like disease of unknown etiology characterized by cutaneous swelling and induration that affects predominantly the extremities, elevated immune globulins, and peripheral eosinophilia. We report three patients with clinical, laboratory and pathologic characteristics of EF. The main symptoms were cutaneous and included "peau d' orange", groove signs and induration of the affected extremities. Two patients had skin changes after exercising and one had a hypothyroidism. None had extra-cutaneous manifestations. All patients had peripheral eosinophilia. Pathologic findings were thickening and inflammation of the fascia and normal epidermis. Only one patient was treated with prednisone 30 mg daily and showed only moderate improvement. There is no follow up information about the other two cases. EF is a rare disorder classified at times as scleroderma variants. However, its clinical picture, capillary microscopy findings, pathology and prognosis differentiate it from systemic sclerosis. (Rev Méd Chile 2002; 130: 209-14) <![CDATA[Macroglosia y amiloidosis oculta]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200012&lng=es&nrm=iso&tlng=es Amyloidosis is a rare disease characterized by the pathological deposit of extracellular proteins in organs or tissues. We report a 78 years old female with a history of euthyroid goiter and carpal syndrome, that presented complaining of weight loss and the sensation of a big and rough tongue. On physical examination, macroglossia and white nodules of 1.5 cm diameter in the mucosa of the mouth, were observed. The pathological examination of these nodules disclosed amyloid infiltration. A bone marrow biopsy showed plasma cell infiltration. The patient was treated with melphalan and prednisone, but she deteriorated progressively and died 14 months after the diagnosis. (Rev Méd Chile 2002; 130: 215-8) <![CDATA[El paciente digestivo funcional refractario: un desafío a la relación médico-paciente]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200013&lng=es&nrm=iso&tlng=es A group of patients with functional disorders of the gastrointestinal tract, manifest symptoms that are chronic, severe and invalidating. Their refractoriness to different treatments is a great challenge for physicians. They normally have a severe psychological and social dysfunction and an abnormal behavior towards their disease. All these factors lead these patients to perpetuate their illness condition. On the other hand, physicians usually have a negative reaction to their demands, leading to a non-satisfactory patient-physician relationship and to the failure of the healing process. Training in the systemic, biopsychosocial model of diseases and in interpersonal communication skills is required for an adequate management of these patients (Rev Méd Chile 2002; 130: 219-25). <![CDATA[Auditoria médica: herramienta de gestión moderna subvalorada]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200014&lng=es&nrm=iso&tlng=es Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee (Rev Méd Chile 2002; 130: 226-9) <![CDATA[Manejo del cáncer gástrico incipiente]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200015&lng=es&nrm=iso&tlng=es Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee (Rev Méd Chile 2002; 130: 226-9) <![CDATA[CONGRESO MUNDIAL DE INFECTOLOGÍA PEDIÁTRICA EN SANTIAGO, 2002]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200016&lng=es&nrm=iso&tlng=es Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee (Rev Méd Chile 2002; 130: 226-9) <![CDATA[<B>FE DE ERRATUM</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000200017&lng=es&nrm=iso&tlng=es Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee (Rev Méd Chile 2002; 130: 226-9)