Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720030004&lang=es vol. 131 num. 4 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Facultad de Medicina de la Universidad de Chile: 170 años al servicio del país]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400001&lng=es&nrm=iso&tlng=es The first course on Medical Sciences in Chile was inaugurated in 1833, being its director William C Blest, MD, an Irish physician graduated in Edinburgh University. Therefore, Dr. Blest can be considered the founder of Chilean formal medical education. When the University of Chile was established (in 1842), among its five initial Faculties was included Medicine, on the basis of the Medical Sciences course created ten years before. By then, the medical profession was not yet socially reputed and the initial years of the Faculty were difficult. During the 19th Century and until the second decade of the 20th century, this was the only medical school in the country. Its development was slow but sustained, reaching its apogee in the middle of the 20th Century, when it had outstanding clinical and basic sciences teachers and investigators. Clinical research, postgraduate teaching and medical specialization had a great development during that period. Nowadays, it is a complex Faculty that teaches eight health sciences courses leading to different professional titles, gives higher academic degrees in biomedicine and public health and certifies different medical specialties. It has a modern, well equipped library and a unique Museum of Medicine. Besides the traditional Departments in Medical Faculties, it has Departments of Medical Teaching, Bioethics and Medical Humanities. It provides continuing medical education programs and distance teaching has recently experienced a great development. The community is also favored with specific teaching programs. The academic promotion of its faculty members is based in a strict evaluation. During its existence, the Faculty has graduated a large number of physicians and other health care professionals. Our country should be grateful to the University of Chile Faculty of Medicine, in its 170th birthday, for its outstanding contribution to the development, welfare and happiness of Chilean society (Rev Méd Chile 2003; 131: 355-8). <![CDATA[Mutación puntual del gen supresor de tumores TP53 en lesiones preneoplásicas y neoplásicas del estómago: <B><I>cross- sectional study in a high risk region</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400002&lng=es&nrm=iso&tlng=es Background: In the current model for the development of gastric cancer, regions of multifocal atrophic gastritis give rise to intestinal metaplasia, dysplasia and finally, adenocarcinoma. Aim: To study the frequency and characteristics of TP53 gene mutations in preneoplastic and neoplastic lesions of the stomach. Material and methods: DNA sequencing of the TP53 gene was performed in 46 patients with gastric carcinoma. Normal mucosa, intestinal metaplasia and invasive adenocarcinoma tissues were obtained by scraping 6-µm histological sections from formalin-fixed and paraffin-embedded tissue. Results: DNA sequencing of exons 5-9 of the TP53 gene demonstrated a mutation in 31% of patients. These findings were seen both in tumoral tissue (13 cases) and in intestinal metaplasia (2 cases). Most mutations were found in exons 5 and 8, and the majority of them were transitions (10 out of 19 mutations). Discussion: Patients with gastric cancer showed a frequency of TP53 mutations similar to that previously communicated in populations with low gastric cancer risk. Moreover, there was a predominance of transitions, genetic alterations that are identified with carcinogenesis associated with N-nitrosamine compounds. Finally, mutations of TP53 gene were detected in areas of intestinal metaplasia (Rev Méd Chile 2003; 131: 359-65). <![CDATA[Correlación entre valores del marcador Ca-125 con la presencia y severidad de endometriosis pelviana]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400003&lng=es&nrm=iso&tlng=es Background: Endometriosis affects at least 15% of infertile women. The diagnosis is made by direct visualization of implants either at laparoscopy or laparotomy. Elevation of plasma CA-125 levels has been associated with the presence of endometriosis. Aim: To search for a correlation between CA-125 and the presence of endometriosis and its severity, among infertile patients requesting a diagnostic laparoscopy. Patients and methods: A total of 117 women were prospectively enrolled in the study between May 2000 and March 2002. A serum sample for CA-125 was taken immediately before surgery and the value obtained was correlated with the presence or absence of endometriosis and the severity of the disease. Results: Sixty nine patients had endometriosis (59%). Patients with severe endometriosis, or grade IV, showed statistically significant higher levels of CA-125 compared to women without endometriosis or with grades I, II or III of the disease. Discussion: The overall sensibility of CA-125 in detecting patients with endometriosis was low, however, it worked better for patients with advanced disease. Considering the rather low cost and simplicity of the test, we believe that it should be included in the evaluation of infertile couples (Rev Méd Chile 2003; 131: 367-72). <![CDATA[Concentraciones plasmáticas de digoxina en cuatro esquemas terapéuticos de uso común en la práctica clínica]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400004&lng=es&nrm=iso&tlng=es Background: The different therapeutic schedules used for the prescription of digoxin have little theoretical support. Aim: To measure digoxin plasma levels in patients using four different prescription schedules. Patients and methods: Four groups of patients were studied. Group I corresponded to 56 patients taking digoxin 0.25 mg/day, from Monday to Friday. Group II corresponded to 30 patients taking digoxin 0.25 mg/day, from Monday to Saturday. Group III corresponded to 53 patients taking digoxin 0.25 mg/day continuosly. Group IV corresponded to 36 patients taking digoxin 0.125 mg/day continuosly. Plasma digoxin levels were measured in two consecutive Mondays before taking the daily dose of the drug. Serum creatinine was also measured and creatinine clearance was calculated. The therapeutic plasma concentration range was set between 0.5 and 2 ng/ml. Results: Mean plasma digoxin levels were 1.15±0.8 ng/ml in group I, 1.4±0.55 ng/ml in group II, 1.68±0.7 ng/ml in group III and 1.14±0.43 ng/ml in group IV. 93% of patients in group I, 80% of patients in group II, 75% of patients in group III and 94% of patients in group IV had therapeutic digoxin levels. A low creatinine clearance, an age over 65 and interactions with other drugs were risk factors associated with supratherapeutic levels, mostly seen in group II and group III with 20% and 24% respectively. Conclusions: Most patients using digoxin with different therapeutic schedules had plasma drug levels within the therapeutic range (Rev Méd Chile 2003; 131: 373-80). <![CDATA[Factores de riesgo cardiovascular en una cohorte de mujeres de edad media]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400005&lng=es&nrm=iso&tlng=es It is generally accepted that menopause significantly modifies cardiovascular risk. The effects of hormone replacement therapy (HRT) on this risk remain controversial. Aim: To study the prevalence of cardiovascular risk factors (RF) in middle-aged women and their changes with aging, menopause and hormone replacement therapy (HRT). Material and methods: cardiovascular risk factors were assessed in 576 women aged 40 to 59 years in 1991-92. Five years later, 467 of these women were reassessed. Results: Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9%, the prevalence of obesity increased to 27.3%, smoking increased to 20.8% and diabetes to 5.9%. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9±56.4 to 136.8±63.5 mg/dl (p <0.001). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8% to 35%. Women on HRT experienced 3% decrease in LDL-cholesterol and 9% increase in HDL-cholesterol levels. Conclusions: Middle aged women included in this cohort have a high prevalence of RF. There is a deterioration with age, but not with menopause. HRT improves the lipid profile (Rev Méd Chile 2003; 131: 381-9). <![CDATA[Canulación de arteria axilar para circulación extracorpórea]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400006&lng=es&nrm=iso&tlng=es Background: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. Aim: To report the experience using the axillary artery for extracorporeal circulation. Patients and methods: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. Results: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 + 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32% were reoperations. In 15 patients (68%), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. Conclusions: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation (Rev Méd Chile 2003; 131: 390-6). <![CDATA[Alta incidencia de diarrea por <I>Clostridium difficile</I> en pacientes nefrológicos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400007&lng=es&nrm=iso&tlng=es Background: Clostridium difficile is the main agent causing antimicrobial associated nosocomial diarrhea. Chronic renal failure is a risk factor for this type of diarrhea. Aim: To study the incidence and complications of Clostridium difficile diarrhea in a university hospital and among patients with renal diseases. Patients and methods: Retrospective review of all cases of Clostridium difficile diarrhea that occurred in a university hospital, between June 2000 and May 2001. Results: In the Nephrology Unit, 48 episodes of Clostridium difficile diarrhea occurred in 35 patients (7 cases per 100 discharges/year). This figure is higher than the global incidence in the hospital (0.53 cases per 100 discharges/year, p <0.001). The mean age of the 33 patients with renal diseases was 63 years old and 17 of them were female. Their main diagnoses were chronic renal failure in hemodialysis in 48%, uremic syndrome in 36% and renal transplant in 6%. Seventy nine percent had a history of antimicrobial use (42% quinolones and 36% cephalosporins). In 3 patients, the only risk factor was chronic renal failure. Seventy five percent responded to metronidazole and in 27%, diarrhea recidivated, compared with a 6% recurrence rate in other units, p <0.02). Eight patients died during hospital stay. Conclusions: Among patients with renal diseases, Clostridium difficile is frequent and associated with a high recurrence rate and mortality. Chronic renal failure may be a risk factor for its development (Rev Méd Chile 2003; 131: -). <![CDATA[Malformaciones congénitas y patología crónica de la madre.: Estudio ECLAMC 1971-1999]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400008&lng=es&nrm=iso&tlng=es Background: Several maternal diseases, such as diabetes mellitus or high blood pressure, are associated with a higher risk for fetal or neonatal problems. Aim: To study the association between chronic diseases of the mother and congenital malformations. Material and methods: Review of the records of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) at the University of Chile Clinical Hospital. A sample of 383 mothers with a chronic disease was compared with 297 healthy mothers. The presence of congenital malformations in the newborns was studied. The odds ratio (OR) of a mother to have a child with a congenital malformation was calculated. Results: Mothers with bronchial asthma, diabetes mellitus, hypertension and hypothyroidism had an OR over 1 of having a child with a congenital malformation. No association between maternal obesity and offspring malformations was observed. Offspring of diabetic mothers had 8.95 times more probabilities of having a major malformation and 4.95 times more probabilities of having a minor defect. Conclusions: Offspring of mothers with diabetes mellitus, bronchial asthma, hypertension or hypothyroidism have a higher risk of presenting a congenital malformation, when compared with offspring of healthy mothers (Rev Méd Chile 2003; 131: 404-11). <![CDATA[<I>Streptococci mutans</I>: Método semi- cuantitativo para establecer el rango de riesgo de infección bucal en niños preescolares chilenos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400009&lng=es&nrm=iso&tlng=es Background: Salivary infection due to Streptococci mutans is considered the main microbiological risk factor for the initiation of dental caries. Aim: To evaluate a semi-quantitative method to assess Streptococci mutans salivary infection and compare it with the existing quantitative method. Patient and methods: Saliva samples were obtained from 650 pre-school children aged 2 to 6 years old using a TYCSB liquid medium for counting Streptococci mutans. Results were compared with quantitative cultures. Results: There was a 99.3% linear correlation coefficient between both methods. The correlation coefficients with dental caries prevalence were 97% for the semi quantitative method and 90% for the quantitative method. Conclusions: The semi-quantitative method to assess oral infection with Streptococci mutans, is accurate enough to be used in population studies and oral infection prevention programs in developing countries (Rev Méd Chile 2003; 131: 412-8). <![CDATA[Intolerancia a la glucosa en niños obesos: comunicación preliminar]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400010&lng=es&nrm=iso&tlng=es Background: Glucose intolerance (GI) is preceded by a prolonged period of Insulin Resistance (IR) and is an advanced stage towards the development of Type 2 Diabetes Mellitus (NIDDM), whose incidence is increasing in the pediatric population, along with obesity. Aim: To describe clinical and metabolic characteristics of obese children according to their glucose tolerance. Patients and Methods: We studied 52 obese children, aged 8 to 17 years, with a body mass index z-score of 4.7±1.6. An oral glucose tolerance test with insulin measurements in the basal period and at 30 minutes, was done. IR was estimated through the Homeostasis Model Assessment index (HOMA) and insulin secretion through the Insulinogenic Index. Results: Six children (11.5%) had GI. When compared with children with normal glucose tolerance, children with GI had similar clinical features, similar HOMA (5.4±3.3 and 5.2±2.0 respectively) and basal insulinemia (23.4±11 and 24.6±10 µU/ml). But they had lower insulin level at 30 min (128±61 and 253.7±357 µU/ml respectively, p >0.05) a lower Insulinogenic Index (1.44±0.4 and 4.4±1.0 µU/ml/mg/dl, p <0.05), a higher total cholesterol (192±37 vs 168±34 mg/dl, p <0.05) and a higher LDL cholesterol (123±35 and 101±28 mg/dl, respectively, p <0.05). Conclusions: Obese children with or without GI have similar clinical features and body mass index. In severe obese children with marked IR, the appearance of Glucose Intolerance seems to be associated to a decrease in insulin secretion and not to an increase in IR (Rev Méd Chile 2003; 131: 419-26). <![CDATA[Síndrome Prader-Willi asociado a obesidad mórbida: tratamiento quirúrgico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400011&lng=es&nrm=iso&tlng=es Prader-Willi Syndrome (PWS) is a multisystemic genetic disease characterized by hypothalamic hypogonadism, mental retardation and compulsive hyperphagia associated with early and severe obesity. Complications of overweight, such as type-2 diabetes Mellitus, dyslipidemia and diffuse atheromatosis are common. We report a 15 years old morbid obese male with PWS, with a body mass index of 57.7 kg/m², refractory to weight-lowering treatments. He underwent preoperative evaluation and treatment by a multidisciplinary team, and subjected to a 95% gastrectomy, leaving a 50 ml remnant pouch and a long limb (120 cm) Y-Roux gastro-jejuno anastomosis. There were no surgical complications, oral feeding was initiated at the 5th day with an hypocaloric diet. During the first postoperative year, the patient lost 70 kg, achieving a body mass index of 30 kg/m². Surgical treatment can become a therapeutic choice for obesity in PWS patients (Rev Méd Chile 2003; 131: 427-31). <![CDATA[Quiste paratiroideo sintomático: A propósito de un caso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400012&lng=es&nrm=iso&tlng=es Parathyroid cysts are unusual and do not have specific clinical manifestations or ultrasonographic findings. Therefore, they are usually confused with thyroid nodules. We report a 43 years old male, with normal thyroid function and normal calcium serum levels, that presented a nodule in the lower right third of the neck. Ultrasonography and CAT scan showed a well delimited 6 x 4.5 cm ovoid cyst that compressed and displaced the trachea and esophagus. A fine needle aspiration was done on three occasions, extracting 18, 40 and 60 ml of liquid. As the cyst recurred and symptoms intensified, the patient was operated removing the cyst and the right thyroid lobe. Pathological study disclosed a parathyroid cyst (Rev Méd Chile 2003; 131: 432-5). <![CDATA[Cuadros tóxicos producidos por mordeduras de araña en Chile: latrodectismo y loxoscelismo]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400013&lng=es&nrm=iso&tlng=es Latrodectism, produced by the bite of Latrodectus spiders, is worldwide distributed, occurs in hot seasons, and affects mostly men when carrying out agricultural activities. The main symptoms are muscular pain and tremors, profuse perspiration, increased lacrimal, nasal and salival secretions, and hypertension. Symptoms last one week. Neostigmine is a very efficient drug in the treatment of this condition. Loxoscelism, caused by the bite of Loxosceles spiders, is worldwide distributed, affects individuals of all ages. It may present two clinical forms: cutaneous loxoscelism (CL) and viscerocutaneous loxoscelism (VCL). Both forms have been registered in all seasons, with a higher incidence in hot periods, and in bedrooms, when the person is sleeping or dressing. The cutaneous surface of limbs and face are most frequently affected. Local clinical manifestations are pain, edema and livedoid plaque, most of which evolve into a necrotic scar in CL, whereas hematuria, hemoglobinuria, jaundice, fever and sensorial involvement characterize VCL. If visceral involvement does not appear within 24 hours, it is probable that the diagnosis corresponds to CL, with a good prognosis. If a VCL patient survives 48 hours, the possibilities of recovery are high. The patients are successfully treated with parenteral antihistamines or corticosteroids in CL and corticosteroids in VCL (Rev Méd Chile 2003; 131: 437-44). <![CDATA[Búsqueda de la atención médica y determinantes de la utilización de Servicios de Salud]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400014&lng=es&nrm=iso&tlng=es There are four different conceptual approaches to assess the factors that explain, condition and determine the use of health services. This article discusses the epidemiological, psychosocial, sociological and economical models. The stages and determinants of the health service use process are described and a cross study is made with each of the four models, using a contingency matrix. A holistic analysis is proposed, as a starting point, for the search of a model that will allow the identification of factors that determine the use of health services. This analysis should be used as a conceptual framework for future work on health services utilization (Rev Méd Chile 2003; 131: 445-53). <![CDATA[Reivindicando la medicina como profesión científico-humanista]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400015&lng=es&nrm=iso&tlng=es There is an urgent need, in our society, to recover the real meaning of medicine as a complex of science and humanistic values committed to person's health care. Following the initiative of the American Board of Internal Medicine, the American College of Physicians and the American Society of Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine, the Medical Professionalism Project has launched a comprehensive declaration to rephrase the social contract between medicine and the society, emphasising the principles and responsibilities that must orient the thoughts and actions of the good physician. The importance, soundness and opportunity of this chart, stimulates an ample dissemination of these concepts and to incorporate them as moral assets, integrating the quality, as experts on a scientific discipline, with the humanistic values provided in these era of increasing bioethical demands (Rev Méd Chile 2003; 131: 454-5). <![CDATA[Profesionalismo médico en el nuevo milenio: Un estatuto para el ejercicio de la medicina]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400016&lng=es&nrm=iso&tlng=es There is an urgent need, in our society, to recover the real meaning of medicine as a complex of science and humanistic values committed to person's health care. Following the initiative of the American Board of Internal Medicine, the American College of Physicians and the American Society of Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine, the Medical Professionalism Project has launched a comprehensive declaration to rephrase the social contract between medicine and the society, emphasising the principles and responsibilities that must orient the thoughts and actions of the good physician. The importance, soundness and opportunity of this chart, stimulates an ample dissemination of these concepts and to incorporate them as moral assets, integrating the quality, as experts on a scientific discipline, with the humanistic values provided in these era of increasing bioethical demands (Rev Méd Chile 2003; 131: 454-5). <![CDATA[Primer reporte en Chile de infección nosocomial del tracto urinario por <I>Trichosporon asahii</I>, en dos pacientes]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400017&lng=es&nrm=iso&tlng=es There is an urgent need, in our society, to recover the real meaning of medicine as a complex of science and humanistic values committed to person's health care. Following the initiative of the American Board of Internal Medicine, the American College of Physicians and the American Society of Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine, the Medical Professionalism Project has launched a comprehensive declaration to rephrase the social contract between medicine and the society, emphasising the principles and responsibilities that must orient the thoughts and actions of the good physician. The importance, soundness and opportunity of this chart, stimulates an ample dissemination of these concepts and to incorporate them as moral assets, integrating the quality, as experts on a scientific discipline, with the humanistic values provided in these era of increasing bioethical demands (Rev Méd Chile 2003; 131: 454-5). http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000400018&lng=es&nrm=iso&tlng=es