Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720020005&lang=es vol. 130 num. 5 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Correlación genotipo-fenotipo de un grupo de pacientes con fibrosis quística]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500001&lng=es&nrm=iso&tlng=es Background: Cystic fibrosis (CF) is the most common lethal autosomic disease in Caucasians, with a global incidence of 1:3000 newborns. More than 900 mutations have been described, involving the Cystic Fibrosis Transmembrane Regulator (CFTR). The ∆F508 mutation is present in 60% of alleles studied worldwide. Aim: To report 25 patients with cystic fibrosis in whom a genetic study was done. Material and methods: Twenty five patients (14 men, aged between 18 months and 25 years) with a diagnosis of cystic fibrosis based on clinical features plus two abnormal sweat tests are reported. The genetic study considered the 20 most common mutations in cystic fibrosis and was done in genomic DNA of peripheral lymphocytes, by polymerase chain reaction. Results: A mutation was found in 75% of analyzed alleles. deltaF508 was present in 50% of cases (deltaF508/deltaF508 in 8 and deltaF508/other in 11). When deltaF508 was present, pancreatic insufficiency was always a feature and nutritional status was worse. Respiratory involvement was variable, both for homozygous and heterozygous cases. Other severe mutations such as W1282X and G542X were related to clinical manifestations similar to those found in deltaF508 mutation. Diagnosis was made before six months of age in 12 patients. The clinical presentation was meconium ileus and there was a family history of the disease in most cases. The majority of cases of early diagnosis presented severe mutations, but milder respiratory symptoms and lesser nutritional compromise at the time of assessment. Conclusions: Most patients studied had a severe cystic fibrosis mutation, which was associated with more severe respiratory, pancreatic and nutritional involvement. The early diagnosis of the disease, which would allow to improve the prognosis and the quality of life, must be emphasized (Rev Méd Chile 2002; 130: 475-81) <![CDATA[Fibrilación auricular focal. Características clínicas y resultado de la ablación con radiofrecuencia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500002&lng=es&nrm=iso&tlng=es Background: Atrial fibrillation can originate in arrhythmogenic foci coming from the pulmonary veins. Patients with atrial fibrillation, initiated from triggering foci, can be treated with radiofrequency ablation. Aim: To report the results of radiofrequency ablation in patients with focal atrial fibrillation. Patients and methods: Thirteen patients with focal atrial fibrillation (8 male, aged 19 to 60 years old) are reported. Twelve had frequent crises refractory to antiarrhythmic drugs. Two had also flutter and tachycardia. One had a permanent atrial fibrillation lasting five years. Two had ventricular dysfunction and left atrial dilatation. The triggering focus was identified during the electrophysiological study, by the precocity of the potential that initiated the atrial fibrillation. Results: All patients had early atrial extrasystolic beats, isolated or repetitives, that preceded atrial fibrillation. During the electrophysiological study, 18 foci (3 in the right and 15 in the left atrium all in pulmonary veins) were identified. Radiofrequency ablation had immediate success in 11 patients. In 5, a flutter was also ablated. One patient had a sinus dysfunction after the procedure and atrial fibrillation was not eliminated. In this and other patient in whom the procedure failed, a pacemaker was implanted and the atrioventricular node was blocked. In a follow up, ranging from 4 to 31 months, eight patients are asymptomatic and 3 recidivated. No complications have been detected. Conclusions: Patients with focal atrial fibrillation have common clinical and electrocardiographic features. Radiofrequency ablation of the triggering focus is possible and effective in most cases (Rev Méd Chile 2002; 130: 482-94) <![CDATA[Situación epidemiológica de las enfermedades transmitidas por alimentos en Santiago de Chile: Período 1999-2000]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500003&lng=es&nrm=iso&tlng=es Background: Foodborne diseases are becoming an important cause of morbidity in Chile. In the Metropolitan Region of Chile, the Environmental Health Service started a surveillance program for foodborne diseases in 1994. In 2000, this program was complemented with an etiologic study of individuals involved in outbreaks. Aim: To report the incidence of foodborne outbreaks in the Metropolitan Region of Chile and its causative agents. Results: One hundred ninety outbreaks of foodborne diseases were reported in 1999 and 260 in 2000. The Southern Metropolitan health service had the higher incidence rates (7.5 in 1999 and 8.2 in 2000). The mean attack rates were 25% in both periods, affecting 1248 individuals in 1999 and 1774 in 2000. In 18% of outbreaks, a pathogen was identified; the most frequent agents were Salmonella Spp, Staphylococcus aureus and Shigella. In 15% of subjects, the cause was histamine or chemical agents. In the rest of the cases, the cause was not identified. The foods with higher risk of causing foodborne diseases were hot prepared dishes, home made goat cheese and meats. Conclusions: The incidence rates of foodborne disease in Metropolitan Area of Chile are high and maybe underestimate, only in a low rate of outbreaks was possible to have samples for etiologic studies. For a better understanding of this problem, timely notification of foodborne diseases must be encouraged and educational campaigns about the proper manipulation of food items must be implemented (Rev Méd Chile 2002; 130: 495-501) <![CDATA[Inmunogenicidad y reactogenicidad de una vacuna de difteria, tétanos, <I>pertussis</I> acelular de contenido antigénico reducido (dTpa) en niños de 10 a 11 años de edad y en adultos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500004&lng=es&nrm=iso&tlng=es Background: New vaccination strategies are needed to control the increasing problem of pertussis in teenagers and adults. Aim: To determine the immunogenicity and reactogenicity of a diphtheria-tetanus-acellular pertussis (dTpa) vaccine with reduced antigen content. Material and Methods: A single dose of the dTpa vaccine was administered to 60 children 10 to 11 years old and 60 healthy adults. At the moment of vaccination and one month later, antibody levels were measured against 3 B pertussis antigens: anti-pertussis toxin (PT), anti-pertactin (PRN) and anti-filamentous hemagglutinin (FHA), as well as anti-tetanus and anti-diphtheria antibodies. Local and general symptoms were registered during 14 days following vaccine administration. Results: Antibody response for PT, FHA and PRN was 98.3%, 100% and 100% in adults and 98.2%, 100% and 98.2% in children. Seropositivity for all pertussis antigens was 100% in adults and in children one month after vaccination. Geometric mean titers (GMT) significantly increased in adults and children. The seroprotection level achieved for tetanus and diphtheria antibodies one month after vaccination was 96.7% for adults and 100% for children, respectively. No serious adverse events were reported during the study. Among local symptoms pain was the most frequent (88-90%), but it was mostly mild or moderate. Solicited general symptoms observed for children and adults, respectively, included headache (37% and 53%), fatigue (18% and 35%) gastrointestinal symptoms (18% and 25%) and fever (8% and 3%). Only one vaccinee had fever above 39°C. Conclusions: the dTpa vaccine showed an adequate safety profile and induced an intense immunological response to all antigens in adults and children aged 10-11 (Rev Méd Chile 2002; 130: 502-10) <![CDATA[Múltiple FISH y múltiple BAND: técnicas de citogenética molecular en cinco casos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500005&lng=es&nrm=iso&tlng=es The techniques of multiple FISH (M-FISH) or fluorescence in situ hybridization with different color assignment for all and each of the human chromosomes, and multiple BAND (M-BAND) or hybridization with different color assignment for each chromosomal band, allow the identification of some alterations that would not be possible to distinguish with classical banding techniques, like the origin of the chromosomal material that constitutes a (non identifiable) marker chromosome or confirming the constitution of the multiple and simultaneous aberrations that occur in cancer cells. We communicate five complex cytogenetic cases that benefited by the employment of this diagnostic strategy, allowing to corroborate or reformulate a previous given conclusion (Rev Méd Chile 2002; 130: 511-18) <![CDATA[Optimización de la reducción de la presión arterial en hipertensos esenciales]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500006&lng=es&nrm=iso&tlng=es Background: A blood pressure below or equal to 140/90 mmHg, the aim of antihypertensive treatment, is rarely achieved. Only 16% of patients controlled by our group reach this goal. Aim: To analyze the causes of suboptimal treatment and to assess the effects of an optimization of antihypertensive therapy. Patients and methods: A random sample of 160 patients was analyzed and followed during one year. Results: Sixty six patients (41%) had a normal blood pressure, maintained during the first three months of follow up. The main causes of suboptimal reduction of blood pressure in the remaining 94 patients were an incorrect prescription or dosage of medications in 37.5%, lack of compliance in 34%, insufficient delivery of medications by the health service in 24% and secondary effects of drugs in 5%. When these factors were corrected, blood pressure normalized in 41 of them. In other 37, a reduction of 5 mmHg or more in blood pressure, was obtained. The most frequent changes introduced were modifications in dosage and addition of a new medication. Therefore, in 90% of these patients, blood pressure was reduced or normalized. Conclusions: A correct identification of the cause of antihypertensive treatment failure is imperative. The correction of this cause leads to a further reduction in blood pressure in 90% of those subjects with suboptimal treatment (Rev Méd Chile 2002; 130: 519-26) <![CDATA[Estudio chileno de prevalencia de patología psiquiátrica (DSM-III-R/CIDI) (ECPP)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500007&lng=es&nrm=iso&tlng=es Background: The Diagnostic and Statistic Manual (DSM) solved the problem of diagnostic criteria for psychiatric diseases. Highly structured interviews such as Composite International Diagnostic Interview (CIDI) allow the evaluation of psychiatric disorders in large samples, whith great accuracy. Aim: To report the prevalence rates of psychiatric disorders in a representative sample of Chilean individuals. Material and methods: The CIDI was administered to 2978 Chilean individuals coming form four provinces. Lifetime and prevalence rates of psychiatric disorders, based in the third revision of the DSM, were calculated. Results: Thirty six percent of the population had a psychiatric disorder at least once in their lifetime and 23% had a disorder in the last six months. The most common lifetime diagnoses were agoraphobia in 11%, major depressive disorders in 9%, dysthymia in 8% and alcohol dependence in 6%. Only 49% of those with a psychiatric disorder sought medical care, while 4% of those individuals considered devoid of psychiatric illnesses, consulted in a mental health facility. Conclusions: The prevalence of psychiatric disorders in the Chilean population is similar to that of other Spanish speaking populations in Latin or North America (Rev Méd Chile 2002; 130: 527-36) <![CDATA[Fracturas mandibulares: Experiencia en un hospital de trauma]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500008&lng=es&nrm=iso&tlng=es Background: Facial trauma has reached a peak in the last decades in the world; however, scanty epidemiological information is available in Chile. Aim: To report the experience in the treatment of mandibular fractures in the maxillofacial unit at Hospital del Trabajador, Santiago. Patients and methods: A retrospective study of patients with mandibular fractures treated in a seven years period (1990-1996). Demographic and clinical aspects of the patients are analyzed, with emphasis in causes of trauma, anatomic distribution of the fractures, treatment and complications. Results: One hundred and sixty patients (aged 14 to 65 years old) sustained 245 mandibular fractures. Road traffic accidents were the most common cause of fractures (46%). The most common mandibular fracture was subcondylar. Thirty eight patients (24%) presented with associated facial fractures, while 34 (21%) had also other non-facial fractures. Open reduction and internal fixation was performed in 88 subjects. Complications occurred in 60 patients (38%). Conclusions: Road traffic accidents are the main cause of mandibular fractures in this series of patients. The most common mandibular fracture is subcondylar, which can be linked to the high rate of occlusal complications observed (Rev Méd Chile 2002; 130: 537-43) <![CDATA[Falla cardio-respiratoria severa tratada con asistencia cardiopulmonar extracorpórea: Caso clínico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500009&lng=es&nrm=iso&tlng=es Cardiopulmonary extracorporeal assistance is a high complexity procedure for patients with acute respiratory failure, who have failed conventional ventilatory support. A 30 years old female patient with bacterial endocarditis and congestive cardiac failure subjected to cardiac surgery presented severe hypoxemia, right heart failure and pulmonary hypertension, and failed conventional treatment. Cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) reverted the pathophysiologic alterations allowing a successful recovery (Rev Méd Chile 2002; 130: 545-50) <![CDATA[Manifestaciones clínicas en 5 casos de enfermedad de Behçet: <I>Report of 5 cases</I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500010&lng=es&nrm=iso&tlng=es Behçet disease is characterized by recurrent oral and genital ulcerations as well as ocular involvement. We report five patients (three women) with this condition. All had oral or genital ulcerations, nodules or pustules. Three patients had an uveitis, two had vestibular involvement and one had a meningoencephalitis. One patient died after a massive hemoptysis (Rev Méd Chile 2002; 130: 551-56) <![CDATA[Litiasis ureteral por Indinavir: <I>Report of one case</I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500011&lng=es&nrm=iso&tlng=es We report a 27 years old male, treated with Indinavir as a prophylactic anti-HIV agent, who consulted for left ureteral pain. Intravenous and retrograde pyelograms disclosed a radioluscent stone, that was removed surgically. The physical-chemical study of the stone, demonstrated indinavir sulphate crystals (Rev Méd Chile 2002; 130: 557-59) <![CDATA[El efecto de variables psicosociales durante el embarazo, en el peso y la edad gestacional del recién nacido]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500012&lng=es&nrm=iso&tlng=es Background: Psychosocial events experienced by pregnant women could have an effect on the newborn. Aim: To study the effects of psychosocial events during pregnancy on the birth weight and gestational age of the newborn. Material and methods: One hundred ninety two pregnant women, coming from urban and rural areas, were interviewed at about 35 weeks of gestation. Information from the obstetrical chart was obtained and different inquiries were applied, about personal history, socioeconomic level, emotional state, vital events, family and social support. Results: Fifty six percent of interviewed women did not plan their pregnancy, 32% considered their pregnancy as a negative event in their life, 62% had symptoms of emotional distress and 81% were unsatisfied with the social support that were receiving. When psychosocial factors were included in the multiple regression analyses, their predictive power for birth weight and gestational age improved. Including these variables, the R2 for birth weight was 0.22 and for gestational age, 0.18. Conclusions: Psychosocial factors during pregnancy are important predictors of birth weight and gestational age of the newborn. Measures should be taken to reduce the impact of these factors on the product of pregnancy (Rev Méd Chile 2002; 130: 561-68) <![CDATA[Artículo de revisión Aplicaciones clínicas del PET]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500013&lng=es&nrm=iso&tlng=es Functional imaging using PET (positron emission tomography) has a great impact on current medical practice. It allows to explore, in a very precise way, different processes such as tissue flow and metabolism. Fluor-deoxyglucose labeled with F18 fluorine represents glucose metabolism. Among its main applications are detection, staging, follow up and recurrence assessment of malignant tumors; myocardial viability detection in patients with myocardial infarction or ischemic cardiomyopathy, and evaluation of hyperactive epileptogenic foci in brain. The basis and clinical applications of PET tomography are reviewed especially oriented to its cost benefit relationship, change in patient management and diagnostic value of the most accepted oncological indications. Important economic resources may be saved with PET in this field, considering appropriate staging and recurrence detection, avoiding expensive therapeutic approaches in advanced disease (Rev Méd Chile 2002; 130: 569-79) <![CDATA[<I>La náusea y el vómito gravídicos</I>: <I>una hipótesis evolutiva</I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500014&lng=es&nrm=iso&tlng=es Nausea and vomiting of pregnancy, "morning sickness", is a common contemporary complaint. Many pregnant patients note alterations in smell and taste which can precipitate "morning sickness", symptoms that characterize early gestation. Epidemiologic studies suggest that pregnancies accompanied by "morning sickness" have better outcomes than asymptomatic pregnancies. The intimate connection between immunogenetic identity, chemoidentity, and chemocommunication by olfactory mechanisms suggests a relationship between maternal symptoms and maternal accommodation of paternal antigens contained in the fetoplacental unit. Most mammalian species utilize olfaction to reduce inbreeding and thus do not require an intimate placental connection between mother and fetus. The evolution of Homo sapiens included prolonged periods of small, genetically homogeneous foraging groups which limited selection of genetically heterogeneous mates. Adaptation to this circumstance included a reduction of olfactory precision in mate selection and a more intimate association between mother and fetus, the hemochorial placenta (Rev Med Chile 2002; 130: 580-84)<hr/>Las náuseas y vómitos al comienzo del embarazo, o "emesis gravídica", son síntomas muy frecuentes. Muchas embarazadas reconocen este estado porque perciben desde los primeros días de un embarazo alteraciones en el olfato y en el sabor que pueden precipitar una emesis gravídica. Hay estudios epidemiológicos que sugieren que los embarazos acompañados por emesis gravídica tienen una mejor evolución que los embarazos asintomáticos. La conexión íntima entre la identidad inmunogenética, la quimioidentidad y la quimiocomunicación mediante mecanismos olfatorios sugieren que existe una relación entre estos síntomas maternos y la adaptación materna a antígenos paternos contenidos en la unidad fetoplacentaria. La mayoría de las especies de mamíferos utilizan el olfato para reducir la consanguinidad y de este modo no necesitan una íntima conexión placentaria entre la madre y el feto. Durante períodos prolongados en la evolución del Homo sapiens hubo grupos pequeños de pastores genéticamente homogéneos, con una limitada posibilidad de seleccionar apareamientos heterogéneos. Su adaptación a esta circunstancia incluyó una disminución de la precisión olfatoria en la selección de apareamientos y una asociación más íntima entre la madre y el feto: la placenta hemocorial <![CDATA[Formación profesional y su acreditación en medicina, un paradigma en garantía de la fe pública]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500015&lng=es&nrm=iso&tlng=es Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice (Rev Méd Chile 2002; 130: 585-89) <![CDATA[¿Desde qué momento hay alma en el embrión humano?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500016&lng=es&nrm=iso&tlng=es Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice (Rev Méd Chile 2002; 130: 585-89) <![CDATA[Redefiniendo el rol de la medicina interna]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000500017&lng=es&nrm=iso&tlng=es Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice (Rev Méd Chile 2002; 130: 585-89)